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Dineen-Griffin S, Benrimoj SI. The landscape of self-care in Australia: A pharmacy perspective. Explor Res Clin Soc Pharm 2024; 13:100396. [PMID: 38174289 PMCID: PMC10762451 DOI: 10.1016/j.rcsop.2023.100396] [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: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
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Affiliation(s)
- Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Spain
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Piquer-Martinez C, Urionagüena A, Benrimoj SI, Calvo B, Dineen-Griffin S, Garcia-Cardenas V, Fernandez-Llimos F, Martinez-Martinez F, Gastelurrutia MA. Theories, models and frameworks for health systems integration. A scoping review. Health Policy 2024; 141:104997. [PMID: 38246048 DOI: 10.1016/j.healthpol.2024.104997] [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] [Received: 05/29/2023] [Revised: 12/23/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Celia Piquer-Martinez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain.
| | - Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Sarah Dineen-Griffin
- College of Health, Medicine and Wellbeing, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, Australia
| | - Victoria Garcia-Cardenas
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain; Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
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Swart A, Benrimoj SI, Dineen-Griffin S. The clinical and economic evidence of the management of urinary tract infections by community pharmacists in women aged 16 to 65 years: a systematic review. Int J Clin Pharm 2024:10.1007/s11096-023-01679-6. [PMID: 38194009 DOI: 10.1007/s11096-023-01679-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Many countries are experiencing an increased demand for health care and a shortage of health professionals in rural areas, impacting an individual's ability to receive timely treatment. The management of uncomplicated urinary tract infections by community pharmacists is usual practice in some regions of the United Kingdom and Canada, and Queensland, Australia. AIM To systematically gather, assess, and synthesize the available peer-reviewed published literature on the management of uncomplicated UTIs by community pharmacists in women aged 16-65 years, provide an understanding of the clinical and economic evidence, while also identifying the essential components of interventions employed. METHOD A systematic review was conducted to identify primary studies detailing interventions for the management of uncomplicated UTIs by community pharmacists. PubMed, PsycINFO, Scopus, Cochrane, CINAHL, EMBASE, and Web of Science were searched to February 2023. Non-primary and qualitative studies were excluded. Study details were recorded in a tailored data extraction form. The quality of studies was assessed using the Joanna Briggs Institute tools. RESULTS Ten publications were included following review of 2129 records. High self-reported cure rates between 84 and 89% and referral rates of about 7% were reported. A single study found pharmacist management was cost effective compared to general practitioner management. No randomized controlled trials were found and papers were of variable quality. CONCLUSION Preliminary evidence suggests pharmacist-led management of uncomplicated UTIs is safe and effective, however no firm conclusion can be provided since the methodologies reported in included studies have significant limitations.
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Affiliation(s)
- Ansonette Swart
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
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Amador-Fernández N, Benrimoj SI, García-Cárdenas V, Gastelurrutia MÁ, Graham EL, Palomo-Llinares R, Sánchez-Tormo J, Baixauli Fernández VJ, Pérez Hoyos E, Plaza Zamora J, Colomer Molina V, Fuertes González R, García Agudo Ó, Martínez-Martínez F. Identification of high-risk patients for referral through machine learning assisting the decision making to manage minor ailments in community pharmacies. Front Pharmacol 2023; 14:1105434. [PMID: 37497107 PMCID: PMC10368471 DOI: 10.3389/fphar.2023.1105434] [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] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Background: Data analysis techniques such as machine learning have been used for assisting in triage and the diagnosis of health problems. Nevertheless, it has not been used yet to assist community pharmacists with services such as the Minor Ailment Services These services have been implemented to reduce the burden of primary care consultations in general medical practitioners (GPs) and to allow a better utilization of community pharmacists' skills. However, there is a need to refer high-risk patients to GPs. Aim: To develop a predictive model for high-risk patients that need referral assisting community pharmacists' triage through a minor ailment service. Method: An ongoing pragmatic type 3 effectiveness-implementation hybrid study was undertaken at a national level in Spanish community pharmacies since October 2020. Pharmacists recruited patients presenting with minor ailments and followed them 10 days after the consultation. The main outcome measured was appropriate medical referral (in accordance with previously co-designed protocols). Nine machine learning models were tested (three statistical, three black box and three tree models) to assist pharmacists in the detection of high-risk individuals in need of referral. Results: Over 14'000 patients were included in the study. Most patients were female (68.1%). With no previous treatment for the specific minor ailment (68.0%) presented. A percentage of patients had referral criteria (13.8%) however, not all of these patients were referred by the pharmacist to the GP (8.5%). The pharmacists were using their clinical expertise not to refer these patients. The primary prediction model was the radial support vector machine (RSVM) with an accuracy of 0.934 (CI95 = [0.926,0.942]), Cohen's kappa of 0.630, recall equal to 0.975 and an area under the curve of 0.897. Twenty variables (out of 61 evaluated) were included in the model. radial support vector machine could predict 95.2% of the true negatives and 74.8% of the true positives. When evaluating the performance for the 25 patient's profiles most frequent in the study, the model was considered appropriate for 56% of them. Conclusion: A RSVM model was obtained to assist in the differentiation of patients that can be managed in community pharmacy from those who are at risk and should be evaluated by GPs. This tool potentially increases patients' safety by increasing pharmacists' ability to differentiate minor ailments from other medical conditions.
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Affiliation(s)
- Noelia Amador-Fernández
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | | | | | - Emma L. Graham
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Rubén Palomo-Llinares
- Department of Public Health and History of Science, University Hospital of Sant Joan d’Alacant, Alicante, Spain
| | - Julia Sánchez-Tormo
- International Virtual Center for Nutrition Research (CIVIN), Alicante, Spain
| | | | - Elena Pérez Hoyos
- Spanish Society of Clinical, Family and Community Pharmacy, Madrid, Spain
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Martínez-Mardones F, Benrimoj SI, Ahumada-Canale A, Plaza-Plaza JC, Garcia-Cardenas V. BC Clinical impact of medication reviews with follow-up in cardiovascular older patients in primary care: A cluster-randomized controlled trial. Br J Clin Pharmacol 2023; 89:2131-2143. [PMID: 36735853 DOI: 10.1111/bcp.15682] [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: 06/23/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
AIMS Cardiovascular diseases (CVD) are the primary cause of death in Chile. Pharmacist-led medication review with follow-up (MRF) has improved CVD risk factors control in Europe and North America. However, their healthcare systems differ from Chile's, precluding generalizability. This trial aimed to determine the effect of MRF on CVD risk factor control among older patients with polypharmacy attending public primary care centres in Chile. METHODS A cluster-randomized controlled trial was conducted in 24 centres. Patients older than 65 years with moderate-to-high CVD risk, five or more medications, hypertension, type 2 diabetes or dyslipidaemia, received MRF in addition to usual care or usual care alone for 12 months. Primary outcome measures were clinical goal achievement for hypertension, type 2 diabetes and dyslipidaemia, as well as medication adherence, medication number and CVD risk score. Adjusted generalized estimating equations were used, with odds ratios (ORs) for binary measures and mean differences for continuous measures. RESULTS In total, 324 patients from 12 centres (174 MRF group, 150 usual care group, six centres each) received four pharmacist visits. Significant improvements were found for goal achievement in hypertension (OR 4.37, 95% confidence interval [CI] 2.54 to 7.51, P = .001), LDL cholesterol (OR 3.67, 95% CI 2.13 to 6.33, P = .001), type 2 diabetes (OR 6.97, 95% CI 3.69 to 13.2, P = .001), medication adherence (OR 6.60, 95% CI 1.36 to 31.9, P = .022), medications number (-0.86, 95% CI -1.14 to -0.58, P < .001) and CVD risk score (-2.27, 95% CI -2.84 to -1.69, P < .001). CONCLUSION Pharmacist-led medication review with follow-up improved cardiovascular disease risk factor control and medication adherence. This study supports pharmacists' inclusion in primary care teams.
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Affiliation(s)
| | | | - Antonio Ahumada-Canale
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jose C Plaza-Plaza
- Faculty of Chemistry and Pharmacy, Pontifical Catholic University of Chile, Santiago, Chile
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Sanchez-Molina AI, Benrimoj SI, Ferri-Garcia R, Martinez-Martinez F, Gastelurrutia MA, Garcia-Cardenas V. Development and validation of a tool to measure collaborative practice between community pharmacists and physicians from the perspective of community pharmacists: the professional collaborative practice tool. BMC Health Serv Res 2022; 22:649. [PMID: 35568892 PMCID: PMC9107731 DOI: 10.1186/s12913-022-08027-w] [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: 07/11/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaborative practice between community pharmacists and physicians is becoming increasingly common. Although tools and models to explore collaborative practice between both health care professionals have been developed, very few have been validated for their use in clinical practice. The objective of this study was to develop and validate a tool for measuring collaborative practice between community pharmacists and physicians from the perspective of community pharmacists. METHODS The DeVellis method was used to develop and validate the Professional Collaborative Practice Tool. A pool of 40 items with Likert frequency scales was generated based on previous literature and expert opinion. This study was undertaken in Spain. A sample of community pharmacists providing medication reviews with follow-up and a random sample of pharmacists providing usual care were invited to participate. Exploratory and confirmatory factor analysis was used to assess the tool's reliability and content validity. RESULTS Three hundred thirty-six pharmacists were invited with an overall response rate of 84.8%. The initial 40 items selected were reduced to 14 items. Exploratory Factor Analysis provided a 3-factor solution explaining 62% of the variance. Confirmatory Factor Analysis confirmed the three factors "Activation for collaborative professional practice," the "Integration in collaborative professional practice," and the "Professional acceptance in collaborative professional practice." The tool demonstrated an adequate fit (X2/df = 1.657, GFI = 0.889 and RMSEA = 0.069) and good internal consistency (Cronbach's alpha = 0.924). CONCLUSIONS The Professional Collaborative Practice Tool has shown good internal reliability and criterion validity. The tool could be used to measure the perceived level of collaborative practice between community pharmacists and physicians and monitor changes over time. Its applicability and transferability to other settings should be evaluated.
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Affiliation(s)
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Ramon Ferri-Garcia
- Department of Statistics and Operations Research, University of Granada, Granada, Spain
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Torres-Robles A, Benrimoj SI, Gastelurrutia MA, Martinez-Martinez F, Peiro T, Perez-Escamilla B, Rogers K, Valverde-Merino I, Varas-Doval R, Garcia-Cardenas V. Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial. BMJ Qual Saf 2022; 31:105-115. [PMID: 33782092 PMCID: PMC8785059 DOI: 10.1136/bmjqs-2020-011671] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 06/01/2020] [Revised: 01/30/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD). METHODS A 6-month cluster randomised controlled trial was conducted in Spanish community pharmacies. Patients suffering from hypertension, asthma and COPD were recruited. Patients in the intervention group received a medication adherence management intervention and the control group received usual care. The intervention was based on theoretical frameworks for changing patient behaviour. Medication adherence, disease-specific outcomes (Asthma Control Questionnaire (ACQ) scores, Clinical COPD Questionnaire (CCQ) scores and blood pressure levels) and disease control were evaluated. A multilevel regression model was used to analyse the data. RESULTS Ninety-eight pharmacies and 1186 patients were recruited, with 1038 patients completing the study. Patients receiving the intervention had an OR of 5.12 (95% CI 3.20 to 8.20, p<0.05) of being adherent after the 6 months. At the end of the study, patients in the intervention group had lower diastolic blood pressure levels (mean difference (MD) -2.88, 95% CI -5.33 to -0.43, p=0.02), lower CCQ scores (MD -0.50, 95% CI -0.82 to -0.18, p<0.05) and lower ACQ scores (MD -0.28, 95% CI -0.56 to 0.00, p<0.05) when compared with the control group. CONCLUSIONS A community pharmacist-led medication adherence intervention was effective at improving medication adherence and clinical outcomes in patients suffering from hypertension, asthma and COPD. Future research should explore the implementation of these interventions in routine practice. TRIAL REGISTRATION NUMBER ACTRN12618000410257.
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Affiliation(s)
- Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Universidad de Granada Facultad de Farmacia, Granada, Andalucía, Spain
| | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, Universidad de Granada Facultad de Farmacia, Granada, Andalucía, Spain
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, Universidad de Granada Facultad de Farmacia, Granada, Andalucía, Spain
| | - Tamara Peiro
- General Pharmaceutical Council of Spain, Madrid, Spain
| | - Beatriz Perez-Escamilla
- Pharmaceutical Care Research Group, Universidad de Granada Facultad de Farmacia, Granada, Andalucía, Spain
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Isabel Valverde-Merino
- Pharmaceutical Care Research Group, Universidad de Granada Facultad de Farmacia, Granada, Andalucía, Spain
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Piquer-Martinez C, Urionagüena A, Benrimoj SI, Calvo B, Martinez-Martinez F, Fernandez-Llimos F, Garcia-Cardenas V, Gastelurrutia MA. Integration of community pharmacy in primary health care: The challenge. Res Social Adm Pharm 2021; 18:3444-3447. [PMID: 35016847 DOI: 10.1016/j.sapharm.2021.12.005] [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: 12/06/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
Community pharmacies and pharmacists predominantly operate in a retail environment independently of other health care providers, and they are not often viewed as an integral member of the healthcare team. Thus, they remain overlooked or excluded during integration processes of health care systems. At the same time, there are calls by the profession at national and international levels for community pharmacy to be integrated within primary care systems. The COVID-19 pandemic appears to have further stimulated this desire. When pressing for integration, various terms, such as integration, integrated care, or interprofessional collaboration, are used in an interchangeable manner leading to lack of clarity, ambiguity and confusion for health care policy makers, planners, and other healthcare professionals. The literature was reviewed to identify critical components for community pharmacy to consider for integration. From the five selected articles describing integration of community pharmacies, four different constructs were identified: consensus, connectivity, communication and trust. The integration of community pharmacy into the health system may translate into better access for patients to primary care services, contribute to cost effectiveness, and promulgate the sustainability of the system. However significant political, economic, social, and practice change would be required by all stakeholders. Further research is needed to underpin a consensus for a definition, the type of integration, and the model optimally suited to integrate community pharmacy into primary care. These models, specific and adaptable to each national health care system and political environment, would need to be consensus-based by principal stakeholders to overcome a variety of barriers, including government resistance. Mere calls or demands by the pharmaceutical profession, although laudable, will not be sufficient to overcome the historical, cultural, and economic challenges.
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Affiliation(s)
| | - Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
| | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | | | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | | | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain; Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
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Amador-Fernández N, Benrimoj SI, García-Mochón L, García-Cárdenas V, Dineen-Griffin S, Gastelurrutia MÁ, Gómez-Martínez JC, Colomer-Molina V, Martínez-Martínez F. A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy. BMC Health Serv Res 2021; 21:1253. [PMID: 34798895 PMCID: PMC8605551 DOI: 10.1186/s12913-021-07188-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/18/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minor ailments are "self-limiting conditions which may be diagnosed and managed without a medical intervention". A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). METHODS The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists' training, practice change facilitators and patients' educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals' consultation time, medication costs, pharmacists' training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. RESULTS A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. CONCLUSIONS Expanding community pharmacists' scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. TRIAL REGISTRATION ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered.
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Affiliation(s)
- Noelia Amador-Fernández
- Pharmaceutical Care Research Group, University of Granada, Campus de Cartuja, Granada, 18071, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Campus de Cartuja, Granada, 18071, Spain
| | | | | | - Sarah Dineen-Griffin
- Health Services Management, School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
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Valverde-Merino MI, Martinez-Martinez F, Garcia-Mochon L, Benrimoj SI, Malet-Larrea A, Perez-Escamilla B, Zarzuelo MJ, Torres-Robles A, Gastelurrutia MA, Varas-Doval R, Peiro Zorrilla T, Garcia-Cardenas V. Cost-Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy. Patient Prefer Adherence 2021; 15:2363-2376. [PMID: 34729007 PMCID: PMC8554318 DOI: 10.2147/ppa.s330371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. PURPOSE To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. MATERIALS AND METHODS The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost-utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost-utility ratio (ICUR) was calculated on the total sample of patients. RESULTS A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case, the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost-utility plane. Using a threshold value of €20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. CONCLUSION The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective.
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Affiliation(s)
| | | | - Leticia Garcia-Mochon
- Department of Management of Health Services and Professionals, Andalusian School of Public Health, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Amaia Malet-Larrea
- Medicines Information Centre, Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastian, Spain
| | | | | | | | | | - Raquel Varas-Doval
- Pharmaceutical Care Services Department, General Pharmaceutical Council of Spain, Madrid, Spain
| | - Tamara Peiro Zorrilla
- Pharmaceutical Care Services Department, General Pharmaceutical Council of Spain, Madrid, Spain
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Varas-Doval R, Saéz-Benito L, Gastelurrutia MA, Benrimoj SI, Garcia-Cardenas V, Martinez-Martínez F. Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies. BMC Health Serv Res 2021; 21:156. [PMID: 33596906 PMCID: PMC7890900 DOI: 10.1186/s12913-021-06150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/19/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.
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Affiliation(s)
- R Varas-Doval
- Spanish General Pharmaceutical Council, Villanueva 11, 28001, Madrid, Spain.
| | - L Saéz-Benito
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Zaragoza, Spain.,Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - M A Gastelurrutia
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - S I Benrimoj
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - V Garcia-Cardenas
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain.,Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Sydney, NSW, Australia
| | - F Martinez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
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Dineen-Griffin S, Benrimoj SI, Williams KA, Garcia-Cardenas V. Co-design and feasibility of a pharmacist-led minor ailment service. BMC Health Serv Res 2021; 21:80. [PMID: 33482801 PMCID: PMC7821549 DOI: 10.1186/s12913-021-06076-1] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Community pharmacies provide an appropriate setting to deliver minor ailment services (MASs). Many community pharmacy services have been developed previously without stakeholder involvement. As a result, implementation of services may fail to produce the expected impact. The aim of this research was to co-design and test the feasibility of an Australian MAS for minor ailment presentations. METHODS This study used co-design methodology which included two phases: (1) a focus group with stakeholders to allow the conceptualization of the service and agreement on service elements; (2) a literature review of clinical guidelines and three working meetings with a team of editors and general practitioners for the development of treatment pathways. Following this, a study evaluating the feasibility of the co-designed service was undertaken. The qualitative part of the methodology associated with the feasibility study comprised semi-structured interviews with MAS pharmacists, observation and completion of a tool by change facilitators identifying barriers and facilitators to service delivery. Qualitative data obtained for all phases were analysed using thematic analysis. RESULTS The developed service included the following components: (i) an in-pharmacy consultation between the patient and pharmacist, (ii) treatment pathways accessible to pharmacists on the internet to guide consultations, (iii) existing digital communication systems used by general practice to exchange patient information, (iv) training, and (v) change facilitation. As a result of feasibility testing, twenty-six implementation factors were identified for practice change, with the main change being the simplification of the pharmacist-patient consultation and data collection processes. CONCLUSIONS An Australian MAS was generated as a result of co-design, while testing revealed that the co-designed service was feasible. As a result of integrating the views of multiple stakeholders, the designed MAS has been adapted to suit healthcare practices, which may increase the acceptance and impact of MAS when implemented into practice.
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13
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Pérez-Escamilla B, Benrimoj SI, Martínez-Martínez F, Gastelurrutia MÁ, Varas-Doval R, Musial-Gabrys K, Garcia-Cardenas V. Using network analysis to explore factors moderating the implementation of a medication review service in community pharmacy. Res Social Adm Pharm 2020; 18:2432-2443. [PMID: 33461944 DOI: 10.1016/j.sapharm.2020.12.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/20/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Implementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered. OBJECTIVES To examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy. METHODS A mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created. RESULTS Implementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy. CONCLUSION Network analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.
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Affiliation(s)
- Beatriz Pérez-Escamilla
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Miguel Ángel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Grupo de Investigación en Atención Farmacéutica, Facultad de Farmacia, Sección de Farmacia Asistencial, Social y Legal, 5(a) planta, 18011, Granada, Spain.
| | - Raquel Varas-Doval
- General Pharmaceutical Council of Spain, Consejo General de Colegios Oficiales de Farmacéuticos, Calle Villanueva 11, 7(a) planta, 28001, Madrid, Spain.
| | - Katarzyna Musial-Gabrys
- University of Technology Sydney, School of Computer Science, Advanced Analytics Institute, School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Victoria Garcia-Cardenas
- University of Technology Sydney, Faculty of Health, Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
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Garcia-Cardenas V, Rossing CV, Fernandez-Llimos F, Schulz M, Tsuyuki R, Bugnon O, Stumpf Tonin F, Benrimoj SI. Pharmacy practice research – A call to action. Res Social Adm Pharm 2020; 16:1602-1608. [DOI: 10.1016/j.sapharm.2020.07.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/01/2022]
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15
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Varas-Doval R, Gastelurrutia MA, Benrimoj SI, García-Cárdenas V, Sáez-Benito L, Martinez-Martínez F. Clinical impact of a pharmacist-led medication review with follow up for aged polypharmacy patients: A cluster randomized controlled trial. Pharm Pract (Granada) 2020; 18:2133. [PMID: 33149794 PMCID: PMC7603656 DOI: 10.18549/pharmpract.2020.4.2133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/18/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Medication review with follow-up (MRF) is a service where community pharmacists undertake a medication review with monthly follow-up to provide continuing care. The ConSIGUE Program assessed the impact and implementation of MRF for aged polypharmacy patients in Spanish Community Pharmacies. The present paper reports on the clinical impact evaluation phase of ConSIGUE. Objective The main objective of the study was to measure the effect of MRF on the primary outcome of the number of uncontrolled health problems. Secondary objectives were to analyze the drug-related problems (DRPs) identified as potential causes of ineffective or unsafe medications and the pharmacists' interventions implemented during MRF provision. Methods An open-label multi-centered cluster randomized study with comparison group (CG) was carried out in community pharmacies from 4 provinces in Spain during 6 months. The main inclusion criteria were patients over 64 years old, using 5 or more medicines. The intervention group (IG) received the MRF service (advanced medication review-type 3 MR) whereas patients in the CG received usual care. Results 178 pharmacies recruited 1403 patients (IG= 688 patients; CG= 715 patients). During the 6 months of the study 72 patients were lost to follow up. The adjusted multi-level random effects models showed a significant reduction in the number of uncontrolled health problems over the periods in the IG (-0.72, 95% CI: -0.80, -0.65) and no change in the CG (-0.03, 95% CI: -0.10, 0.04). Main DRPs identified as potential causes of failures of uncontrolled health problems' treatment were undertreated condition (559 DRPs; 35.81%), lack of treatment adherence (261 DRP; 16.67%) and risk of adverse effects (207 DRPs; 13.53%). Interventions performed by pharmacist to solve DRP mainly included the addition (246 interventions; 14.67%) and change (330 interventions; 19.68%) of a medicine and educational interventions on medicine adherence (231 interventions; 13.78%) and non-pharmacological interventions (369 interventions; 22.01%). Conclusions This study provides evidence of the impact of community pharmacist on clinical outcomes for aged patients. It suggests that the provision of an MRF in collaboration with general medical practitioners and patients contributes to the improvement of aged polypharmacy patients' health status and reduces their problems related with the use of medicines.
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Affiliation(s)
- Raquel Varas-Doval
- M.Pharm, BPharm, Pharmaceutical Services, Department of Innovation and Education, Spanish General Council of Official Pharmacists Associations. Madrid (Spain).
| | - Miguel A Gastelurrutia
- PhD, MSc, BPharm. Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
| | - Shalom I Benrimoj
- PhD, BPharm (hons). Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
| | - Victoria García-Cárdenas
- PhD, MPharm, BPharm. Senior Lecturer, Graduate School of Health, Discipline of Pharmacy University of Technology Sydney. Sydney, NSW (Australia).
| | - Loreto Sáez-Benito
- PhD, MPharm. Teaching and Research Academic Staff, Faculty of Health Sciences, San Jorge University. Zaragoza (Spain).
| | - Fernando Martinez-Martínez
- PhD, BPharm. Professor, Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
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16
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Varas-Doval R, Gastelurrutia MA, Benrimoj SI, Zarzuelo MJ, Garcia-Cardenas V, Perez-Escamilla B, Martínez-Martínez F. Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice. BMJ Open 2020; 10:e036669. [PMID: 32994235 PMCID: PMC7526286 DOI: 10.1136/bmjopen-2019-036669] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT). SETTING Community pharmacies in Spain. PARTICIPANTS 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over. INTERVENTION The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT. RESULTS 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed. CONCLUSIONS The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete. TRIAL REGISTRATION NUMBER CGFTRA-2017-01.
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Affiliation(s)
- Raquel Varas-Doval
- Department of Pharmaceutical Services, Spanish General Council of Official Colleges of Pharmacists, Madrid, Spain
| | - Miguel A Gastelurrutia
- Pharmaceutical Care Research Group, CTS-131, University of Granada Faculty of Pharmacy, Granada, Spain
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, CTS-131, University of Granada Faculty of Pharmacy, Granada, Spain
| | - Maria Jose Zarzuelo
- Pharmaceutical Care Research Group, CTS-131, University of Granada Faculty of Pharmacy, Granada, Spain
| | | | - Beatriz Perez-Escamilla
- Pharmaceutical Care Research Group, CTS-131, University of Granada Faculty of Pharmacy, Granada, Spain
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17
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Dineen-Griffin S, Vargas C, Williams KA, Benrimoj SI, Garcia-Cardenas V. Cost utility of a pharmacist-led minor ailment service compared with usual pharmacist care. Cost Eff Resour Alloc 2020; 18:24. [PMID: 32742199 PMCID: PMC7388462 DOI: 10.1186/s12962-020-00220-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/21/2020] [Accepted: 07/17/2020] [Indexed: 01/16/2023] Open
Abstract
Background A cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC. Methods Participants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively. Results Patients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), compared to UC (n = 370) which resulted in an ICER of $2277 (95% CI $681.49–3811.22) per QALY. Conclusion Economic findings suggest that implementation of MAS within the Australian context is cost effective. Trial registration Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Constanza Vargas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW Australia
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
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Franco-Trigo L, Fernandez-Llimos F, Martínez-Martínez F, Benrimoj SI, Sabater-Hernández D. Stakeholder analysis in health innovation planning processes: A systematic scoping review. Health Policy 2020; 124:1083-1099. [PMID: 32829927 DOI: 10.1016/j.healthpol.2020.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/16/2018] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
Integrating health innovations into the health system is a complex endeavour that requires a well-designed planning process engaging key stakeholders. Stakeholder analyses lay the foundations to inform appropriate planning processes and undertake strategic actions. A systematic scoping review was performed to explore how stakeholder analyses are applied in health innovation planning processes and a guideline to report stakeholder analyses was developed. The literature search was conducted in PubMed, Scopus and DOAJ; grey literature was sought using Google. Articles reporting stakeholder analyses during the planning process of health policies, systems, products and technologies, and services and delivery methods were included. Fifty-one records were incorporated in the qualitative synthesis. Stakeholder analyses were conducted worldwide, used in all types of health innovations, applied in all phases of the planning process and conducted both prospectively and retrospectively. The steps followed to perform stakeholder analysis, the methods used, the stakeholder attributes analysed and how authors reported the analyses were heterogeneous. Forty-one studies reported the identification of stakeholders, 50 differentiated/categorised them and 25 analysed stakeholder relationships. Only some authors proposed future actions based on the results obtained in their stakeholder analysis. A list of Reporting Items for Stakeholder Analysis (i.e., the RISA tool) is proposed to contribute to the reporting guidelines to enhancing the quality and transparency of health research.
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Affiliation(s)
- L Franco-Trigo
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St. Ultimo. NSW 2007 PO Box 123, Australia; MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
| | - F Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal.
| | - F Martínez-Martínez
- MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
| | - S I Benrimoj
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St. Ultimo. NSW 2007 PO Box 123, Australia.
| | - D Sabater-Hernández
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St. Ultimo. NSW 2007 PO Box 123, Australia; MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
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Abstract
There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.
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Affiliation(s)
- Sarah Dineen-Griffin
- PhD, GradCertPharmPrac, MPharm, BBSci. University of Technology Sydney. Sydney, NSW (Australia).
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Abstract
The interrelationship between governmental policies and objectives in primary health care and community pharmacy/pharmacists’ strategic plans are of the outmost importance, having significant professional, economic and practical consequences for the future of the pharmacy profession, research, education and health care. Sharing information of the potential and real impact on current and future practice of community pharmacy/pharmacists, be it in product or service, in primary care would benefit many stakeholders. In order to create and focus professional and scientific debate the journal has commissioned key experts to contribute a series of country case studies. The aim of the series is to promulgate and disseminate country-based information on primary health care and community pharmacy/pharmacist.
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Affiliation(s)
- Shalom I Benrimoj
- PhD. Editorial Board member, Pharmacy Practice. Emeritus Professor University of Sydney. Sydney (Australia).
| | - Fernando Fernandez-Llimos
- PhD, MPharm, MBA. Editor-in-chief, Pharmacy Practice. Laboratory of Pharmacology, Department of Drug Sciences, College of Pharmacy, University of Porto. Porto (Portugal)
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21
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Dineen-Griffin S, Benrimoj SI, Rogers K, Williams KA, Garcia-Cardenas V. Cluster randomised controlled trial evaluating the clinical and humanistic impact of a pharmacist-led minor ailment service. BMJ Qual Saf 2020; 29:921-931. [PMID: 32139400 DOI: 10.1136/bmjqs-2019-010608] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/11/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Community pharmacists are well positioned to support patients' minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared with usual pharmacist care (UC). METHODS A cluster randomised controlled trial was conducted. Intervention patients received MAS, which included a consultation with the pharmacist. MAS pharmacists were trained in clinical pathways and communication systems mutually agreed with general practitioners and received monthly support. Control patients received UC. All patients were followed up by telephone at 14 days. Clinical and humanistic impact were defined by primary (appropriate referral rate and appropriate non-prescription medicine rate) and secondary outcomes (clinical product-based intervention rate, referral adherence, symptom resolution, reconsultation and EuroQol EQ-5D visual analogue scale (VAS)). RESULTS Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow-up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% CI 1.07 to 2.11; p=0.018) and were five times more likely to adhere to referral, compared with UC (RR=5.08; 95%CI 2.02 to 12.79; p=0.001). MAS patients (94%) achieved symptom resolution or relief at follow-up, while this was 88% with UC (RR=1.06; 95% CI 1 to 1.13; p=0.035). MAS pharmacists were 1.2 times more likely to recommend an appropriate medicine (RR 1.20, 95% CI 1.1 to 1.3; p=0.000) and were 2.6 times more likely to perform a clinical product-based intervention (RR=2.62, 95% CI 1.28 to 5.38; p=0.009), compared with UC. MAS patients had a greater mean difference in VAS at follow-up (4.08; 95% CI 1.23 to 6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95% CI 0.75 to 1.28; p=0.89). CONCLUSION The study demonstrates improved clinical and humanistic outcomes with MAS. National implementation is a means to manage minor ailments more effectively in the Australian health system. TRIAL REGISTRATION NUMBER ACTRN12618000286246.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Martínez-Mardones F, Fernandez-Llimos F, Benrimoj SI, Ahumada-Canale A, Plaza-Plaza JC, S Tonin F, Garcia-Cardenas V. Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care. J Am Heart Assoc 2019; 8:e013627. [PMID: 31711390 PMCID: PMC6915276 DOI: 10.1161/jaha.119.013627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 12/14/2022]
Abstract
Background Pharmacists‐led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta‐analysis was to analyze the impact of pharmacist‐led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs. Methods and Results Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist‐led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta‐analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta‐analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05–7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17–5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05–3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low‐density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present. Conclusions Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities.
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Affiliation(s)
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.ULisboa) Department of Social Pharmacy Faculty of Pharmacy University of Lisbon Portugal
| | - Shalom I Benrimoj
- Member of the Pharmaceutical Care Research Group University of Granada Faculty of Pharmacy Campus Universitario Cartuja Granada Spain
| | | | | | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme Federal University of Paraná Curitiba Brazil
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Moussa L, Garcia-Cardenas V, Benrimoj SI. Change Facilitation Strategies Used in the Implementation of Innovations in Healthcare Practice: A Systematic Review. Journal of Change Management 2019. [DOI: 10.1080/14697017.2019.1602552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lydia Moussa
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | - Shalom I. Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Franco-Trigo L, Marqués-Sánchez P, Tudball J, Benrimoj SI, Martínez-Martínez F, Sabater-Hernández D. Collaborative health service planning: A stakeholder analysis with social network analysis to develop a community pharmacy service. Res Social Adm Pharm 2019; 16:216-229. [PMID: 31133537 DOI: 10.1016/j.sapharm.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/14/2018] [Revised: 04/27/2019] [Accepted: 05/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stakeholder participation optimizes health planning, fostering the acceptability and integration of new health services. Collaborative approaches may help overcome existing challenges in the development, implementation and evaluation of community pharmacy services (CPSs). Stakeholder analyses lay the foundation for building collaboration in the integrated delivery of health care. OBJECTIVES This stakeholder analysis was performed to organize a collaborative initiative to develop a CPS aimed at preventing cardiovascular diseases in Andalucía (Spain). It aimed to identify stakeholders, differentiate/categorize them, and analyze stakeholder relationships. METHOD Stakeholders were identified using the snowballing technique. To differentiate/categorize stakeholders and analyze the relationships (i.e., collaboration) an online web-based questionnaire was sent to 186 stakeholders. Stakeholders were asked for: (1) their influence, interest and attitude toward the initiative; (2) stakes/interests; (3) capacity to contribute to the initiative; (4) desire for involvement; (5) concerns; (6) whom they considered a key stakeholder; and (7) the level of collaboration they had with other stakeholders. Data analysis combined descriptive qualitative content analysis, descriptive quantitative analysis and social network analysis. RESULTS Of the 186 stakeholders approached, 96 (51.6%) participated. The identification process yielded 217 stakeholders (individuals, organizations or collectives), classified into 10 groups. Fifty-seven stakeholders were considered critical to the intended initiative. Most participant stakeholders supported the initiative and were willing to collaborate in the development of the CPS. Public health and science were the main driving interests. A collaboration network existed between the 96 stakeholders. CONCLUSION This study revealed the magnitude of the social system surrounding the development of a CPS aimed at preventing cardiovascular disease. A large array of stakeholders was identified and analyzed, and a group of critical stakeholders selected. Stakeholder characteristics such as attitude toward the initiative, potential contribution, desire for involvement, and the existing collaboration network, provided complementary information that was helpful for planning the process and stakeholder engagement.
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Affiliation(s)
- L Franco-Trigo
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St, Ultimo, NSW, 2007, (PO Box 123), Australia; MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
| | - P Marqués-Sánchez
- SALBIS Research Group. Faculty of Health Sciences, University of Leon, Campus of Ponferrada s/n, 24401, Ponferrada, León, Spain.
| | - J Tudball
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St, Ultimo, NSW, 2007, (PO Box 123), Australia.
| | - S I Benrimoj
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St, Ultimo, NSW, 2007, (PO Box 123), Australia.
| | - F Martínez-Martínez
- MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
| | - D Sabater-Hernández
- Graduate School of Health, University of Technology Sydney. Level 4, Building 7, 67 Thomas St, Ultimo, NSW, 2007, (PO Box 123), Australia; MJFD Academic Centre of Pharmaceutical Care, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain; Pharmaceutical Care Research Group, University of Granada. Faculty of Pharmacy, Campus Universitario Cartuja S/N, 18071, Granada, Spain.
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Wiecek E, Tonin FS, Torres-Robles A, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Temporal effectiveness of interventions to improve medication adherence: A network meta-analysis. PLoS One 2019; 14:e0213432. [PMID: 30861014 PMCID: PMC6413898 DOI: 10.1371/journal.pone.0213432] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Received: 07/18/2018] [Accepted: 02/21/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Adherence-enhancing interventions have been assessed in the literature, however heterogeneity and conflicting findings have prohibited a consensus on the most effective approach to maintain adherence over time. With the ageing population and growth of chronic conditions, evaluation of sustainable strategies to improve and maintain medication adherence long term is paramount. We aimed to determine the comparative effectiveness of interventions for improving medication adherence over time among adults with any clinical condition. Materials and methods Meta-analyses evaluating interventions to improve medication adherence were searched in PubMed in January 2019 and reviewed for primary studies. Experimental studies with a comparison group assessing an intervention to enhance medication adherence in adult patients with reported adherence outcomes were included. Two authors extracted data for study characteristics, interventions and adherence outcomes. Interventions were categorized into four groups or combinations: educational, attitudinal, technical and rewards. Four network meta-analyses were performed to compare interventions based on patient follow-up time. Medication adherence effect sizes were reported as odds ratios (OR) with a 95% credibility interval (CrI) and surface under the cumulative ranking curve (SUCRA) to allow ranking probabilities. Risk of bias was assessed as per Cochrane guidelines. Results Data was obtained from 69 meta-analyses with 468 primary studies being included in qualitative synthesis. The four networks compromised of 249 studies in total (0–3 month follow-up: 99 studies, 4–6 months: 104, 7–9 months: 18, ≥10 months: 94). Interventions showing success in follow-ups of less than 10 months varied across time. Significant effects compared to standard of care (SOC) were found in technical (4–6 months: OR 0.34, 95% CrI 0.25–0.45) and attitudinal interventions (7–9 months: 0.37, 0.17–0.84). Multicomponent interventions demonstrated effectiveness compared to standard of care with an additive effect displayed, particularly in longer follow-ups (educational + attitudinal + technical interventions ≥10 months: OR 0.49, 95% CrI 0.27–0.88). Discussion All interventions reviewed improved medication adherence compared to standard of care. Multicomponent interventions displayed the most promising results in maintenance of long-term medication adherence. Technical and reward components enhanced adherence on a short-term basis, while educational and attitudinal interventions evolved over time to be more effective in follow-ups greater than 7 months. Sustainability of adherence to medications over time is dependent upon multicomponent interventions including educational, attitudinal and technical aspects to modify and enhance patient medication-taking behavior. Future research should focus on the most cost-effective approaches able to be integrated into routine practice.
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Affiliation(s)
- Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.UL), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Torres-Robles A, Wiecek E, Cutler R, Drake B, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Using Dispensing Data to Evaluate Adherence Implementation Rates in Community Pharmacy. Front Pharmacol 2019; 10:130. [PMID: 30863308 PMCID: PMC6399119 DOI: 10.3389/fphar.2019.00130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 08/03/2018] [Accepted: 02/05/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Medication non-adherence remains a significant problem for the health care system with clinical, humanistic and economic impact. Dispensing data is a valuable and commonly utilized measure due accessibility in electronic health data. The purpose of this study was to analyze the changes on adherence implementation rates before and after a community pharmacist intervention integrated in usual real life practice, incorporating big data analysis techniques to evaluate Proportion of Days Covered (PDC) from pharmacy dispensing data. Methods: Retrospective observational study. A de-identified database of dispensing data from 20,335 patients (n = 11,257 on rosuvastatin, n = 6,797 on irbesartan, and n = 2,281 on desvenlafaxine) was analyzed. Included patients received a pharmacist-led medication adherence intervention and had dispensing records before and after the intervention. As a measure of adherence implementation, PDC was utilized. Analysis of the database was performed using SQL and Python. Results: Three months after the pharmacist intervention there was an increase on average PDC from 50.2% (SD: 30.1) to 66.9% (SD: 29.9) for rosuvastatin, from 50.8% (SD: 30.3) to 68% (SD: 29.3) for irbesartan and from 47.3% (SD: 28.4) to 66.3% (SD: 27.3) for desvenlafaxine. These rates declined over 12 months to 62.1% (SD: 32.0) for rosuvastatin, to 62.4% (SD: 32.5) for irbesartan and to 58.1% (SD: 31.1) for desvenlafaxine. In terms of the proportion of adherent patients (PDC >= 80.0%) the trend was similar, increasing after the pharmacist intervention from overall 17.4 to 41.2% and decreasing after one year of analysis to 35.3%. Conclusion: Big database analysis techniques provided results on adherence implementation over 2 years of analysis. An increase in adherence rates was observed after the pharmacist intervention, followed by a gradual decrease over time. Enhancing the current intervention using an evidence-based approach and integrating big database analysis techniques to a real-time measurement of adherence could help community pharmacies improve and sustain medication adherence.
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Affiliation(s)
- Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rachelle Cutler
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Barry Drake
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Torres-Robles A, Wiecek E, Tonin FS, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Comparison of Interventions to Improve Long-Term Medication Adherence Across Different Clinical Conditions: A Systematic Review With Network Meta-Analysis. Front Pharmacol 2018; 9:1454. [PMID: 30618748 PMCID: PMC6311651 DOI: 10.3389/fphar.2018.01454] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Medication non-adherence has a dynamic, temporal and multifactorial nature with a significant impact on economic and clinical outcomes. Interventions to improve adherence are complex and require adaptation to patients' needs, which may include patient's medical conditions. The aim of this study was to assess the comparative effectiveness of medication adherence interventions per type of clinical condition on adult patients. Methods: A systematic review with network meta-analysis was performed (PROSPERO registration number of CRD42018054598). An initial Pubmed search was conducted to select meta-analyses reporting results of interventions aiming to improve medication adherence. Primary studies were selected and those reporting results with a long-term follow up (≥10 months) on adult patients were included for data extraction. Study characteristics, description of interventions and adherence outcomes were extracted. Adherence interventions were classified in four groups: educational, attitudinal, technical, and rewards. Clinical conditions were classified in four groups: circulatory system and metabolic diseases, infectious diseases, musculoskeletal diseases, and mental, behavioral or neurodevelopmental disorders. Network meta-analyses with effect sizes expressed as odds ratio (OR) with a 95% credibility interval (CrI) were built. Ranking probabilities for each measure of adherence were calculated by using surface under the cumulative ranking analysis (SUCRA). Results: A total of 61 meta-analysis and 149 primary studies were included in the qualitative synthesis and 80 primary studies in the quantitative analysis. The most effective interventions were: educational + technical 79.6% [OR: 0.44 (CrI: 0.26, 0.73)] and 73.3% [OR: 0.56 (0.36, 0.84)] in circulatory system and metabolic diseases and infectious diseases respectively. Attitudinal intervention had the greatest probability for musculoskeletal diseases of 92.3% in SUCRA [OR: 0.30 (0.10, 0.86)]. Finally, educational + attitudinal interventions had the greatest effect (SUCRA 73.8%) for mental, behavioral or neurodevelopmental disorders, although this was not significant according to consistency analysis. Conclusion: Effectiveness of interventions seems to be related to the clinical condition. Educational and technical interventions resulted in a major effect on long-term management of medication adherence in patients with infectious diseases (HIV) and circulatory system and metabolic diseases whereas attitudinal components presented a higher effect on musculoskeletal and mental, behavioral or neurodevelopmental disorders.
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Affiliation(s)
- Andrea Torres-Robles
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elyssa Wiecek
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines (iMed.Ulisboa), Universidade de Lisboa, Lisbon, Portugal
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Hossain LN, Tudball J, Franco-Trigo L, Durks D, Benrimoj SI, Sabater-Hernández D. A multilevel stakeholder approach for identifying the determinants of implementation of government-funded community pharmacy services at the primary care level. Res Social Adm Pharm 2018; 14:765-775. [DOI: 10.1016/j.sapharm.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
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Zeater S, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. A model for the financial assessment of professional services in community pharmacy: A systematic review. J Am Pharm Assoc (2003) 2018; 59:108-116.e1. [PMID: 30661641 DOI: 10.1016/j.japh.2018.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Limited studies have assessed the financial benefit of professional pharmacy services (PPSs) to the community pharmacy as a business. These studies are crucial in developing an insight into the long-term sustainability and broader implementation of services. We reviewed the literature to identify measures and indicators used to assess the financial performance of professional services in community pharmacy. DATA SOURCES The literature search was undertaken in Pubmed and Scopus, and a gray literature search was performed in Google.com. References of the included papers were reviewed for other relevant studies. STUDY SELECTION Articles were reviewed against the following exclusion criteria: 1) literature reviews, 2) studies not reporting quantitative financial data from community pharmacy, 3) studies not assessing a PPS, 4) studies lacking a methodology for the measurement and assessment of financial outcomes, and 5) cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis studies. DATA EXTRACTION A piloted data extraction form was used. A selection of key data collected is as follows: 1) method of data collection and calculation, 2) currency, limitations for cost and revenue and method of data collection and method of calculation, 3) standardized currency value for the results reported, 4) professional services: number assessed, type of service, name of services, nature of services, implementation stage reported, financial result, the frequency of service, costs, sources of revenue, net total cost, net total revenue, break-even point, break-even price, net profit and loss. RESULTS The 21 studies included used different methodologies and indicators to financially assess PPSs. This has led to the development of a model for assessing PPSs composed of the key financial elements identified in this systematic review. CONCLUSION From this review, we propose a model that provides a structured approach for pharmacists to manage the financial performance of services.
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Malet-Larrea A, Arbillaga L, Gastelurrutia MÁ, Larrañaga B, Garay Á, Benrimoj SI, Oñatibia-Astibia A, Goyenechea E. Defining and characterising age-friendly community pharmacies: a qualitative study. Int J Pharm Pract 2018; 27:25-33. [PMID: 29693292 DOI: 10.1111/ijpp.12451] [Citation(s) in RCA: 2] [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: 07/19/2017] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Global Network of Age-friendly Cities is a project promoted by the World Health Organization as a response to demographic ageing and urbanization process. San Sebastian, Spain, is one of these Age-friendly Cities and community pharmacies of the city joined the initiative. OBJECTIVE To define and implement the Age-friendly Pharmacy concept to promote active ageing, optimize the contribution of community pharmacies of San Sebastian to the friendliness of the city and to the improvement of quality of life of the ageing population. METHOD A bottom-up participative approach was undertaken. A focus group was conducted to determine elderly people's opinions and expectations of community pharmacy. The information obtained was analysed using content analysis and validated for reliability, usefulness and applicability through three expert groups of community pharmacy owners and staff. KEY FINDINGS Fifteen requirements were agreed, covering four main areas: relationships, pharmacy layout, pharmaceutical services and communication of services. Initially, 18 community pharmacies committed to become Age-friendly Pharmacies by pledging to these requirements and the Official Pharmacist Association of Gipuzkoa supported pharmacies in the implementation of the initiative. CONCLUSION This study suggests that there is demand for a patient-centred community pharmacy to support older people, in which pharmaceutical care services are required. The 18 Age-friendly Pharmacies together with the Official Pharmacist Association of Gipuzkoa have publicly committed to actively work on social and patient-centred care to meet the needs of the ageing population.
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Affiliation(s)
- Amaia Malet-Larrea
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | - Leire Arbillaga
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | | | - Belén Larrañaga
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | - Ángel Garay
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Sabater-Hernández D, Tudball J, Ferguson C, Franco-Trigo L, Hossain LN, Benrimoj SI. A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation. BMC Health Serv Res 2018; 18:145. [PMID: 29486758 PMCID: PMC6389098 DOI: 10.1186/s12913-018-2947-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/10/2017] [Accepted: 02/19/2018] [Indexed: 12/29/2022] Open
Abstract
Background Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. Methods A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacy-based health programs was used to build a theoretical model of the service. Results Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). Conclusion A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting. Electronic supplementary material The online version of this article (10.1186/s12913-018-2947-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Sabater-Hernández
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia. .,Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain.
| | - Jacqueline Tudball
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia
| | - Caleb Ferguson
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia
| | - Lucía Franco-Trigo
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia.,Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
| | - Lutfun N Hossain
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology, Level 4, Building 7, 67 Thomas St, PO Box 123, Ultimo, Sydney, Australia
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Crespo-Gonzalez C, Fernandez-Llimos F, Rotta I, Correr CJ, Benrimoj SI, Garcia-Cardenas V. Characterization of pharmacists' interventions in asthma management: A systematic review. J Am Pharm Assoc (2003) 2018; 58:210-219. [PMID: 29439927 DOI: 10.1016/j.japh.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/13/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the "amount of program delivered," and core components of the intervention provided by pharmacists in asthma management. DATA SOURCES A literature search was conducted in December 2016 using PubMed. STUDY SELECTION A 2-stage approach was used. At the first stage, systematic reviews of pharmacists' interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. DATA EXTRACTION The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions' core components. RESULTS Thirty-one studies were included. In most of the studies, the pharmacist-patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists' interventions were the provision of drug information and patient counseling (n = 27). Pharmacists' interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. CONCLUSION Pharmacists' interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists' interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their implementation in practice. (Registration number CRD42016029181.).
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Benson H, Lucas C, Benrimoj SI, Kmet W, Williams KA. Pharmacists in general practice: recommendations resulting from team-based collaborative care. Aust J Prim Health 2018; 24:448-454. [DOI: 10.1071/py18022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/19/2018] [Indexed: 11/23/2022]
Abstract
The Western Sydney Primary Health Network (PHN), WentWest, has been working to improve patient and health system outcomes by commissioning projects that enhance patient-focussed, team-based care. One such project is the WentWest General Practice Pharmacist Project, involving the integration of pharmacists within general practice sites. The aim of this study is to describe, classify and analyse recommendations made by pharmacists to GPs, resulting from patient consultations between pharmacists and patients in a general practice setting. This study was a multi-centre prospective observational study (April 2017–September 2017) investigating recommendations made by pharmacists integrated in a general practice setting. Thirteen general practice sites located in Western Sydney, NSW, Australia were involved in the study. The main outcome measures of this study include the classification of pharmacist recommendations and the percentage of those recommendations accepted by GPs. The pharmacists recorded the results from 618 patient consultations. These consultations resulted in 1601 recommendations of which 1404 (88%) were recorded as accepted. This study demonstrated that the recommendations made by pharmacists in general practice are well accepted by GPs and may lead to improvements in medication management and patient care.
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Aly M, García-Cárdenas V, Williams K, Benrimoj SI. WITHDRAWN: A Review Of International Pharmacy- Based Minor Ailment Services And Proposed Service Design Model. Res Social Adm Pharm 2017:S1551-7411(17)30469-2. [PMID: 29275152 DOI: 10.1016/j.sapharm.2017.12.006] [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] [Received: 05/06/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Mariyam Aly
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Victoria García-Cárdenas
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, PO Box 123 Broadway NSW 2007, Sydney, New South Wales, Australia.
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Malet-Larrea A, Goyenechea E, Gastelurrutia MA, Calvo B, García-Cárdenas V, Cabases JM, Noain A, Martínez-Martínez F, Sabater-Hernández D, Benrimoj SI. Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients. Eur J Health Econ 2017; 18:1069-1078. [PMID: 27913940 DOI: 10.1007/s10198-016-0853-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient's health outcomes through an optimization of the medication. OBJECTIVE To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis. METHODS The economic evaluation was based on a cluster randomized controlled trial. Patients in the intervention group (IG) received the MRF service and the comparison group (CG) received usual care. The analysis was conducted from the national health system (NHS) perspective over 6 months. Direct medical costs were included and expressed in euros at 2014 prices. Health benefits were estimated by assigning a monetary value to the quality-adjusted life years. One-way deterministic sensitivity analysis was undertaken in order to analyse the uncertainty. RESULTS The analysis included 1403 patients (IG: n = 688 vs CG: n = 715). The cost analysis showed that the MRF saved 97 € per patient in 6 months. Extrapolating data to 1 year and assuming a fee for service of 22 € per patient-month, the estimated savings were 273 € per patient-year. The cost-benefit ratio revealed that for every 1 € invested in MRF, a benefit of 3.3 € to 6.2 € was obtained. CONCLUSION The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.
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Affiliation(s)
- Amaia Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain.
| | - Estíbaliz Goyenechea
- Official Pharmacist Association of Guipúzcoa, Prim 2, 20006, San Sebastián, Spain
| | - Miguel A Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain
| | - Victoria García-Cárdenas
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Juan M Cabases
- Department of Economics, Public University of Navarra, Campus Arrosadía, 31006, Pamplona, Spain
| | - Aránzazu Noain
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Daniel Sabater-Hernández
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Hossain LN, Fernandez-Llimos F, Luckett T, Moullin JC, Durks D, Franco-Trigo L, Benrimoj SI, Sabater-Hernández D. Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners. BMJ Open 2017; 7:e015471. [PMID: 28877940 PMCID: PMC5588935 DOI: 10.1136/bmjopen-2016-015471] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia. METHODS A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach. RESULTS Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education. CONCLUSIONS Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.
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Affiliation(s)
- Lutfun N Hossain
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Fernando Fernandez-Llimos
- Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines, University of Lisbon, Lisboa, Portugal
| | | | - Joanna C Moullin
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Desire Durks
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Lucia Franco-Trigo
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Daniel Sabater-Hernández
- Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
- Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
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Durks D, Fernandez-Llimos F, Hossain LN, Franco-Trigo L, Benrimoj SI, Sabater-Hernández D. Use of Intervention Mapping to Enhance Health Care Professional Practice: A Systematic Review. Health Educ Behav 2017; 44:524-535. [DOI: 10.1177/1090198117709885] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Intervention Mapping is a planning protocol for developing behavior change interventions, the first three steps of which are intended to establish the foundations and rationales of such interventions. Aim. This systematic review aimed to identify programs that used Intervention Mapping to plan changes in health care professional practice. Specifically, it provides an analysis of the information provided by the programs in the first three steps of the protocol to determine their foundations and rationales of change. Method. A literature search was undertaken in PubMed, Scopus, SciELO, and DOAJ using “Intervention Mapping” as keyword. Key information was gathered, including theories used, determinants of practice, research methodologies, theory-based methods, and practical applications. Results. Seventeen programs aimed at changing a range of health care practices were included. The social cognitive theory and the theory of planned behavior were the most frequently used frameworks in driving change within health care practices. Programs used a large variety of research methodologies to identify determinants of practice. Specific theory-based methods (e.g., modelling and active learning) and practical applications (e.g., health care professional training and facilitation) were reported to inform the development of practice change interventions and programs. Discussion. In practice, Intervention Mapping delineates a three-step systematic, theory- and evidence-driven process for establishing the theoretical foundations and rationales underpinning change in health care professional practice. Conclusion. The use of Intervention Mapping can provide health care planners with useful guidelines for the theoretical development of practice change interventions and programs.
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Affiliation(s)
- Desire Durks
- University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Daniel Sabater-Hernández
- University of Technology Sydney, Sydney, New South Wales, Australia
- University of Granada, Granada, Spain
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Crespo-Gonzalez C, Garcia-Cardenas V, Benrimoj SI. The next phase in professional services research: From implementation to sustainability. Res Social Adm Pharm 2017; 13:896-901. [PMID: 28602278 DOI: 10.1016/j.sapharm.2017.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/29/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022]
Abstract
The provision of professional pharmacy services has been heralded as the professional and the economic future of pharmacy. There are different phases involved in a service creation including service design, impact evaluation, implementation and sustainability. The two first phases have been subject to extensive research. In the last years the principles of Implementation science have been applied in pharmacy to study the initial uptake and integration of evidence-based services into routine practice. However, little attention has been paid to the sustainability of those services, during which there is a continued use of the service previously implemented to achieve and sustain long-term outcomes. The objective of this commentary is to describe the differences and common characteristics between the implementation and the sustainability phase and to propose a definition for pharmacy. A literature search was performed. Four critical elements were identified: 1. The aim of the implementation phase is to incorporate new services into practice, the sustainability phase's aim is to make the services routine to achieve and sustain long-term benefits 2. At the implementation phase planned activities are used as a process to integrate the new service, at the sustainability phase there is a continuous improvement of the service 3. The implementation phase occurs during the period of time between the adoption of a service and its integration. Some authors suggest the sustainability phase is a concomitant phase with the implementation phase and others suggest it is independent 4. There is a lack of consensus regarding the duration of each phase. The following definition of sustainability for pharmacy services is proposed: "Sustainability is a phase in the process of a professional pharmacy service, in which the service previously integrated into practice during the implementation phase is routinized and institutionalized over time to achieve and sustain the expected service outcomes". An agreement on a definition will facilitate an understanding of when the profession has reached this ultimate goal.
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Affiliation(s)
- Carmen Crespo-Gonzalez
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
| | - Victoria Garcia-Cardenas
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
| | - Shalom I Benrimoj
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
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Fuller JM, Saini B, Bosnic-Anticevich S, Garcia Cardenas V, Benrimoj SI, Armour C. Testing evidence routine practice: Using an implementation framework to embed a clinically proven asthma service in Australian community pharmacy. Res Social Adm Pharm 2017; 13:989-996. [PMID: 28583300 DOI: 10.1016/j.sapharm.2017.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 05/05/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Community pharmacists are well placed and evidence clearly demonstrates that they can be suitably trained to deliver professional services that improve the management of asthma patients in clinical, economic and humanistic terms. However the gap between this evidence and practice reality remains wide. In this study we measure the implementation process as well as the service benefits of an asthma service model. METHODS Using an effectiveness-implementation hybrid design, a defined implementation process (progression from Exploration through Preparation and Testing to Operation stages) supporting an asthma service (promoting asthma control and inhaler technique) was tested in 17 community pharmacies across metropolitan Sydney. RESULTS Seven pharmacies reached the Operation stage of implementation. Eight pharmacies reached the Testing stage of implementation and two pharmacies did not progress beyond the Preparation stage of implementation. A total of 128 patients were enrolled in the asthma service with 110 patients remaining enrolled at the close of the study. Asthma control showed a positive trend throughout the service with the overall proportion of patients with 'poor' asthma control at baseline decreasing from 72% to 57% at study close. There was a statistically significant increase in the proportion of patients with correct inhaler technique from 12% at Baseline (Visit 1) to 33% at Visit 2 and 57% at study close. CONCLUSION Implementation of the asthma service varied across pharmacies. Different strategies specific to practice sites at different stages of the implementation model may result in greater uptake of professional services. The asthma service led to improved patient outcomes overall with a positive trend in asthma control and significant change in inhaler technique.
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Affiliation(s)
- Joanne M Fuller
- The Graduate School of Health, University of Technology Sydney, Sydney, Australia; The Woolcock Institute of Medical Research, Sydney, Australia.
| | - Bandana Saini
- The Woolcock Institute of Medical Research, Sydney, Australia; Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Sinthia Bosnic-Anticevich
- The Woolcock Institute of Medical Research, Sydney, Australia; Sydney Local Health District, Sydney, Australia
| | | | - Shalom I Benrimoj
- The Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Carol Armour
- The Woolcock Institute of Medical Research, Sydney, Australia; Sydney Local Health District, Sydney, Australia
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Sabater-Galindo M, Sabater-Hernández D, Ruiz de Maya S, Gastelurrutia MA, Martínez-Martínez F, Benrimoj SI. Modelling elderly patients’ perception of the community pharmacist image when providing professional services. PSYCHOL HEALTH MED 2017; 22:578-587. [DOI: 10.1080/13548506.2016.1192654] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sabater-Hernández D, Sabater-Galindo M, Fernandez-Llimos F, Rotta I, Hossain LN, Durks D, Franco-Trigo L, Lopes LA, Correr CJ, Benrimoj SI. A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease. J Manag Care Spec Pharm 2017; 22:699-713. [PMID: 27231797 PMCID: PMC10398089 DOI: 10.18553/jmcp.2016.22.6.699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. OBJECTIVES To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. METHODS This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. RESULTS From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. CONCLUSIONS This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD. DISCLOSURES Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.
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Affiliation(s)
- Daniel Sabater-Hernández
- 1 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia, and Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
| | | | - Fernando Fernandez-Llimos
- 3 Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisboa, Lisbon, Portugal
| | - Inajara Rotta
- 4 PostGraduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Lutfun N Hossain
- 7 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Desire Durks
- 8 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Lucia Franco-Trigo
- 9 School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Livia A Lopes
- 5 Post-Graduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Cassyano J Correr
- 6 Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
| | - Shalom I Benrimoj
- 10 School of Health University of Technology Sydney, Sydney, Australia
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Sabater-Galindo M, Ruiz de Maya S, Benrimoj SI, Gastelurrutia MA, Martínez-Martínez F, Sabater-Hernández D. Patients' expectations of the role of the community pharmacist: Development and testing of a conceptual model. Res Social Adm Pharm 2017; 13:313-320. [DOI: 10.1016/j.sapharm.2016.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/15/2022]
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Malet-Larrea A, García-Cárdenas V, Sáez-Benito L, Benrimoj SI, Calvo B, Goyenechea E. Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:747-758. [DOI: 10.1080/14737167.2016.1259071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - V García-Cárdenas
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - L Sáez-Benito
- Faculty of Health Sciences, Pharmacy Department, San Jorge University, Villanueva de Gállego, Zaragoza, Spain
| | - SI Benrimoj
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - B Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - E Goyenechea
- Technical Management Department, Official Pharmacist Association of Guipuzcoa, Donostia-San Sebastian, Spain
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Moullin JC, Sabater-Hernández D, Benrimoj SI. Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis. BMC Health Serv Res 2016; 16:439. [PMID: 27562631 PMCID: PMC4997770 DOI: 10.1186/s12913-016-1689-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 08/13/2015] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published. METHODS Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation. RESULTS Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking. CONCLUSIONS The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.
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Affiliation(s)
- Joanna C. Moullin
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
| | - Daniel Sabater-Hernández
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
- Academic Centre in Pharmaceutical Care, Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja s/n. C.P. 18071, Granada, Spain
| | - Shalom I. Benrimoj
- Graduate School of Health, University of Technology Sydney, Level 4, Building 7, 67 Thomas St Ultimo, (PO Box 123 Broadway), Ultimo, 2007 NSW Australia
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Malet-Larrea A, Goyenechea E, García-Cárdenas V, Calvo B, Arteche JM, Aranegui P, Zubeldia JJ, Gastelurrutia MA, Martínez-Martínez F, Benrimoj SI. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br J Clin Pharmacol 2016; 82:831-8. [PMID: 27195696 DOI: 10.1111/bcp.13012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 11/11/2015] [Revised: 04/12/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs. METHODS This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months. Pharmacists in the comparison group (CG) delivered usual care. For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations. Inter-rater reliability was measured using Fleiss's kappa. Hospital costs were calculated using diagnosis related groups. RESULTS One thousand four hundred and three patients were included in the main study and they had 83 hospitalizations. Forty-two hospitalizations (50.6%) were medicine-related, with a substantial level of agreement among the experts (kappa = 0.65, 95% CI 0.52, 0.78, P < 0.01). The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0.042). The probability of being hospitalized was 3.7 times higher in the CG (odds ratio 3.7, 95% CI 1.2, 11.3, P = 0.021). Costs for a medicine-related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018]. CONCLUSION MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy.
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Affiliation(s)
- Amaia Malet-Larrea
- Pharmaceutical Technology Department, University of the Basque Country, Vitoria-Gasteiz
| | | | | | - Begoña Calvo
- Pharmaceutical Technology Department, University of the Basque Country, Vitoria-Gasteiz
| | - Jose M Arteche
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | - Pedro Aranegui
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | - Jose J Zubeldia
- Internal Medicine Department, Donostia Hospital, Donostia-San Sebastian
| | | | | | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Garcia-Cardenas V, Benrimoj SI, Ocampo CC, Goyenechea E, Martinez-Martinez F, Gastelurrutia MA. Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report. Res Social Adm Pharm 2016; 13:614-627. [PMID: 27423785 DOI: 10.1016/j.sapharm.2016.05.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1-5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.
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Affiliation(s)
- Victoria Garcia-Cardenas
- Graduate School of Health, University of Technology Sydney, P.O. Box 123 Broadway, New South Wales 2007, Sydney, Australia.
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, P.O. Box 123 Broadway, New South Wales 2007, Sydney, Australia
| | - Carla Castrillon Ocampo
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
| | | | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
| | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
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Moullin JC, Sabater-Hernández D, García-Corpas JP, Kenny P, Benrimoj SI. Development and testing of two implementation tools to measure components of professional pharmacy service fidelity. J Eval Clin Pract 2016; 22:369-77. [PMID: 26710985 DOI: 10.1111/jep.12496] [Citation(s) in RCA: 8] [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] [Accepted: 11/16/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES There is a need to evaluate both service process and implementation outcomes as professional services are being implemented into pharmacy practice. Fidelity is an implementation outcome, which may be used for service optimization, by associating service components to patient outcomes, as well as use in process evaluation. The objective of this study was to develop tools to measure components of fidelity, specifically, an adherence index (adherence of the service provider to the elements of the service) and a patient responsiveness scale for the professional pharmacy service, medication review with follow-up. METHODS The procedure described by DeVellis was followed to develop the tools. An expert panel was used to create items and establish content validity. Primary data were collected from 190 service provider pharmacists from 128 pharmacies across 11 provinces of Spain using Spanish version tools as part of an ongoing implementation study (English translations appended to the online version of the article as supplementary material). An initial assessment of item functionality was performed using descriptive statistics and item discrimination for both tools. The patient responsiveness scale's internal consistency was confirmed by calculating Cronbach's alpha coefficient and inter-item correlations. In addition, for the patient responsiveness scale, the number of factors to retain was based on Kaiser criterion, parallel analysis and Cattell's scree test and the number of items was optimized as guided by iterative exploratory factor analysis (EFA). RESULTS Acceptability of both tools was high. An adherence index of 39 items was developed. After five EFA iterations, four items were removed, resulting in a reliable, 12-item, two-factor patient responsiveness scale, explaining 53.9% of total variance. CONCLUSIONS Two tools for measuring implementation fidelity, an adherence index and a patient responsiveness scale, have been developed and tested. Future assessment, in particular to establish criterion validity, is recommended.
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Affiliation(s)
- Joanna C Moullin
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.,Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | | | - José P García-Corpas
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Patricia Kenny
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Moullin JC, Sabater-Hernández D, Benrimoj SI. Model for the evaluation of implementation programs and professional pharmacy services. Res Social Adm Pharm 2016; 12:515-22. [DOI: 10.1016/j.sapharm.2015.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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