Pharmaceutical Care

To ascertain patients', providers', and managers' perceptions of the factors that contributed to the success of the Asheville Project. Design: One-time focus groups of patients and diabetes care providers and individual interviews with managers involved in the project. Setting: The City of Asheville and Mission-St. Joseph's Health System (MSJ), Asheville, N.C. Patients and Other Participants: Twenty-one patients with diabetes who were employees of the two self-insured employers participating in the Asheville Project; four specially trained pharmacists who provided diabetes-related pharmaceutical care and one diabetes educator, all of whom received reimbursement for their services; six managers employed by the City of Asheville or MSJ who were involved in the project. Intervention: A trained facilitator conducted four focus groups and six manager interviews in September 2001. Each session lasted 60 to 90 minutes, and the facilitator used a standard list of open-ended questions. The focus group sessions were recorded for subsequent analysis. Main Outcome Measures: Perceptions of focus group participants and managers of how the Asheville Project enabled patients with diabetes to become more responsible and successful in self-managing their condition. Results: Focus group participants and managers were enthusiastic about their experiences with the project. Patients valued the relationships they established with their pharmacist or diabetes educator; as a result of these providers' support, patients felt more in control of their lives and were healthier. The waived co-payments for diabetes medications and related supplies was the decisive incentive for getting many patients to enroll in the project. For the providers, the project was a source of professional growth and satisfaction. Managers felt the project helped them fulfill their health care responsibilities to their employees, reduced overall costs, enhanced their organizations' reputations in health care delivery, and resulted in less absenteeism. Conclusion: Patients, providers, and managers in the Asheville Project believed that aligned incentives and community-based resources that provide health care services to patients with diabetes offer a practical, patient-empowering, and cost-effective solution to escalating health care costs.

At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise.On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct

Objective: To understand and describe the meaning of medications for patients. Methods: A metasynthesis of three different, yet complementary qualitative research studies, was conducted by two researchers. The first study was a phenomenological study of patients' medication experiences that used unstructured interviews. The second study was an ethnographic study of pharmaceutical care practice, which included participant observation, in-depth interviews and focus groups with patients of pharmaceutical care. The third was a phenomenological study of the chronic illness experience of medically uninsured individuals in the United States and included an explicit aim to understand the medication experience within that context. The two researchers who conducted these three qualitative studies that examined the medication experience performed the meta-synthesis. The process began with the researchers reviewing the themes of the medication experience for each study. The researchers then aggregated the themes to identify the overlapping and similar themes of the medication experience and which themes are sub-themes within another theme versus a unique theme of the medication experience. The researchers then used the analytic technique, ''free imaginative variation'' to determine the essential, structural themes of the medication experience. Results: The meaning of medica-tions for patients was captured as four themes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control. The medication experience is an individual's subjective experience of taking a medication in his daily life. It begins as an encounter with a medication. It is an encounter that is given meaning before it occurs. The experience may include positive or negative bodily effects. The unremitting nature of a chronic medication often causes an individual to question the need for the medication. Subsequently, the individual may exert control by altering the way he takes the medication and often in part because of the gained expertise with the medication in his own body. Conclusion: The medication experience is a practice concept that serves to understand patients' experiences and to understand an individual patient's medication experience and medicationtaking behaviors in order to meet his or her medicationrelated needs.

The primary purpose of this study was to investigate influences on pharmacists' over-the-counter (OTC) recommendations. A structured survey questionnaire covering medical, social, and marketing factors related to eight OTC product categories was designed and reviewed by a jury of experts and subsequently mailed to one-half of the 1440 pharmacies in Indiana. A total of 526 pharmacists responded to the questionnaire, providing a 73.1% response rate. Findings revealed that pharmacists were most likely to make favorable OTC recommendations related to nutritional supplements and smoking cessation products. Results also indicated that medical forces were significantly more important in influencing OTC product decisions than social and marketing forces. Based on the findings in this study, pharmacists are making OTC product recommendations in accordance with their health care training and expertise.

The aim of the present article is to reveal the repercussion that educational innovations carry out by the Clinical Pharmacy and Pharmacotherapy Unit, University of Barcelona, have had in the pharmacists' learning process, mainly in the pharmaceutical practice, almost done in the last 20 years. During this time, the Unit was recognized, in the year 2000, as an Innovation Group,

This manuscript presents an argument for a broader use of qualitative methodologies to investigate the practice and the surroundings of pharmaceutical care. Albeit the use of qualitative research methods is growing in the health care field, it is still insufficient in the area of pharmaceutical care. Pharmaceutical care, as a patientcentered practice, calls for a more comprehensive and humanistic approach to research. It is our contention that the attempt to understand pharmaceutical care practice from the perspective of patients, pharmacists and other health care professionals, by means of using qualitative methods, would notably contribute to a better assessment of the value of pharmaceutical care programs in the health care system. Moreover, because a deeper understanding of the nuances of this practice can be achieved with the use of qualitative methods, this approach might also assist us in making the necessary changes to create more effective pharmaceutical care practices.

Background: Because community pharmacists are encouraged to provide clinical services, there is a need to determine the role perceptions of both community pharmacists and general practitioners (primary care physicians). Differing role perceptions are likely to result in barriers to pharmacists expanding their roles in health care. Objectives: The purpose of this study was to investigate whether community pharmacists' and general practitioner's perceptions of the role of community pharmacists may be a barrier to pharmacists increasing their role in medication management. Other potential barriers were also explored that could provide a framework for future research. Methods: A postal survey to 900 and 1000 randomly selected community pharmacists and general practitioners, respectively, elicited the perceptions of these groups toward the role of community pharmacists. Likert scales were used to quantify the results. Results: The results revealed a gap in perceptions regarding the role of the community pharmacist, with general acceptance of the technical roles but less acceptance of clinical roles by general practitioners. Barriers to increased involvement of community pharmacists in clinical services included a perceived lack of mandate, legitimacy, adequacy, and effectiveness by both groups. Also observed was a lack of readiness to change by community pharmacists. Conclusions: This study suggests that there are significant barriers to community pharmacists increasing clinical services, both from the community pharmacists themselves and from the general practitioners. Attention to change management in a complex environment will be necessary if community pharmacists are to change their role toward more clinical services.

As doenças hepáticas são responsáveis pela morte de milhares de pessoas em todo o mundo. As lesões hepáticas evoluem cronicamente para a cirrose hepática (CH), a qual é responsável por complicações secundárias à hipertensão portal e insuficiência hepática. O objetivo deste estudo foi realizar uma revisão sobre CH e suas principais complicações (hemorragia digestiva alta varicosa - HDAv, encefalopatia hepática, ascite e peritonite bacteriana espontânea - PBE), com o conhecimento direcionado ao farmacêutico, abrangendo a fisiopatologia e a farmacologia clínica empregada no tratamento de pacientes acometidos pela CH descompensada.
Palavras chaves: cirrose hepática, farmacêutico e farmacologia clínica.
Abstract (HEPATIC CIRRHOSIS AND ITS MAJOR COMPLICATIONS: KNOWLEDGE DIRECTED TO THE PHARMACIST): Hepatic diseases are responsible for the death of thousands of people worldwide. The hepatic lesions evolve chronically to cirrhosis, which is responsible for complications secondary to portal hypertension and hepatic insufficiency. The aim of this study was to perform a review about hepatic cirrhosis and its major complications (varicose digestive hemorrhage, hepatic encephalopathy, ascites and spontaneous bacterial peritonitis), with the knowledge directed to the pharmacist, covering the pathophysiology of this disease and the clinical pharmacology used in the treatment of patients with decompensated cirrhosis. Keywords: liver cirrhosis, pharmacist and clinical pharmacology.

Objetivo: Describir la estrategia de difusión de servicios farmacéuticos mediante los medios de comunicación a través de campañas de atención farmacéutica en la Farmacia Institucional de la Dirección General de Medicamentos Insumos y Drogas (DIGEMID) del Ministerio
de Salud de Perú ubicada en la ciudad de Lima. Material y métodos: Estudio observacional, descriptivo, transversal, que incluye a pacientes
que acuden a las campañas en la farmacia institucional, quienes reciben al menos uno de los 3 servicios siguientes: 1) información sobre el uso de medicamentos usando un atril con láminas informativas, 2) medición de la presión arterial y, 3) seguimiento farmacoterapéutico
para identificar y hacer intervenciones sobre los problemas relacionados con medicamentos encontrados (PRM). Para generar la difusión de estas actividades se generan notas de prensa desde el Ministerio de Salud y se hacen llegar a los medios de comunicación de radio y televisión para que realicen la cobertura de la actividad. Resultados: Durante las campañas se busca tener cobertura periodística de emisoras de radio y canales de televisión (de señal abierta y cerrada). El tiempo promedio de entrevista para cada medio televisivo/radial fluctúa entre fue 3 a 8 minutos. Algunos videos y audios de las campañas realizadas o la ampliación de los temas de las campañas se encuentran
disponibles en YouTube y otras páginas Web. Conclusión: La difusión mediante los medios de comunicación de las campañas farmacéuticas
permite mostrar a la población de modo específico los servicios farmacéuticos enmarcados en la atención farmacéutica.

Pharmacy profession has evolved from its conventional and traditional drug focused basis to an advanced patient focused basis over the years. In the past century the pharmacists were more involved in compounding and manufacturing of medicines, but this role has significantly reduced over time. This advancement in the role of pharmacist calls for them to be the part of the broader health care team working for providing better health care for the patients, thus contributing in achieving the global millennium development goals. To match up, the role of today's pharmacists needs to be expanded to include pharmaceutical care concepts, making the pharmacist a health care professional rather than a drug seller in a commercial enterprise. Therefore, pharmacy schools should prepare a program that has competence with the changing role of the pharmacist. The education should provide ability for critical thinking, improve problem-solving skills and decision making during pharmacotherapy. The student should be trained to create, transmit, and apply new knowledge based on cutting-edge research in the pharmaceutical, social, and clinical sciences; collaborate with other health professionals and learn to enhance the quality of life through improved health for the people of local society and as well as the global community.

SUMMARY ñ Quality of life is a primary health outcome in the cost effectiveness analysis, to monitor the adverse effects and the clinical practice. The life quality of patients with hepatitis C can be diminished due the hepatic disease development, to extra-hepatic symptoms or cognitive alterations. This study is a literary research review, which assesses the life quality of patients

Introduction
Consultation rooms in community pharmacies offer patients an easily accessible private area that can be utilised for confidential consultations with a healthcare professional. Consultation rooms were introduced in England and Wales in 2005 in order to carry out pharmaceutical services. However, there are no legal requirements for building private pharmacy consultation facilities in Poland. The aim of this article is to review the regulations and international standards for building consultation rooms in community pharmacies and to assess customer’s feedback about these facilities post-implementation in England. This will set the standards to develop polish requirements for this particular type of the facility.
Material and methods
A self-administered, anonymous questionnaire was distributed to pharmacy-visiting patients between March 2011 and August 2011. Altogether, 417 individuals from Poland (voievodships: mazowieckie, pomorskie, dolnoslaskie) and 405 individuals from England (counties: Cambridgeshire, Essex, Northamptonshire, Norfolk) filled in the questionnaire and their responses were included in the present analyses. Comparisons were performed using Anova test. All statistical analyses were performed using Statistica 8.0. Ethics committee approval was not required.
Results
The results indicate that Polish patients express interest in a pharmacy private consultation room. Furthermore the study allowed us to assess the 7 years experience of using the consulting facility in British community pharmacy where patients are highly satisfied with the option of a private consultation with a pharmacist.
Conclusions:
Polish patients express an interest in the possibility of having a consultation in a private facility located within a pharmacy other then the pharmacy counter. English patients express relatively high level of satisfaction with the use of such consultations areas.

Keywords: Consultation room, pharmaceutical care, community pharmacy
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Monte Carlo simulations in the isotension-isothermal and Gibbs ensembles were carried out to investigate the structural properties of warfarin sodium 2-propanol and the ability of this compound to retain 2-propanol as a function of vapor pressure and in the presence of water. At full loading, the simulations yield a stable solvate structure that is in good agreement with the experimentally determined crystal structure. 2-Propanol is well-retained by the warfarin sodium host, and full loading is observed for partial pressures as low as 1% of its saturated vapor pressure, while water does not substantially replace 2-propanol from the crystalline interior even at 100% relative humidity. Radial distribution functions show strong binding of 2-propanol's hydroxyl hydrogen with the 2-keto oxygen and the oxygen atom of the coumarin ring of warfarin and strong binding of 2-propanol's oxygen to a single sodium ion. Thus, the spatial position of 2-propanol is highly confined, supporting the experimental observation that the 2:1 adduct of warfarin sodium and 2-propanol is a true solvate and not a clathrate. In contrast, water molecules would be less constrained and two water molecules would fit into 2-propanol's binding site, but there is no channel for the transport of water or 2-propanol molecules.

Interventions by the pharmacists have always been considered as a valuable input by the health care community in the patient care process by reducing the medication errors, rationalizing the therapy and reducing the cost of therapy. The primary objective of this study was to determine the number and types of medication errors intervened by the dispensing pharmacists at OPD pharmacy in the Khoula Hospital during 2009 retrospectively. The interventions filed by the pharmacists and assistant pharmacists in OPD pharmacy were collected. Then they were categorized and analyzed after a detailed review. The results show that 72.3% of the interventions were minor of which 40.5% were about change medication order. Comparatively more numbers of prescriptions were intervened in female patients than male patients. 98.2% of the interventions were accepted by the prescribers reflecting the awareness of the doctors about the importance of the pharmacy practice. In this study only 688 interventions were due to prescribing errors of which 40.5% interventions were done in changing the medication order of clarifying the medicine. 14.9% of the interventions were related to administrative issues, 8.7% of the interventions were related to selection of medications as well as errors due to ignorance of history of patients. 8.2% of the interventions were to address the overdose of medications. Moderately significant interventions were observed in 19.4% and 7.5% of them were having the impact on major medication errors. Pharmacists have intervened 20.8% of the prescriptions to prevent complications, 25.1% were to rationalize the treatment, 7.9% of them were to improve compliance. Based on the results we conclude that the role of pharmacist in improving the health care system is vital. We recommend more number of such research based studies to bring awareness among health care professionals, provide solution

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented. One critical aspect of reducing health disparities is moving health care providers, staff, administrators, and practices toward increased cultural competence and proficiency. Effective delivery of culturally and linguistically appropriate service in cross-cultural settings is identified as cultural competence. Culture is a dynamic process, with people moving in and out of various cultures throughout their lives. The failure to understand and respect individuals and their cultures could impede pharmaceutical care. Incongruent beliefs and expectations between the patient and pharmacist could lead to misunderstandings, confusion, and ultimately to drug misadventures. Models and frameworks have been developed that provide descriptions of the process by which individuals, practice settings, and organizations can become culturally competent and proficient. This article, the first in a five-part series, presents an overview of issues related to cultural competence in health care with an emphasis on the pharmacy profession. Also provided are definitions for cultural competence and related terms, a brief overview of health disparities and challenges to the common morality, and a discussion of models and frameworks that describe pathways to cultural competence and proficiency.

Objectives: To develop and test a framework for evaluating the consultation skills of practitioners undertaking medication-related consultations. Methods: Key components of medication-related consultations were identified through a literature review and compiled to form an initial consultation skills framework. This was iteratively refined through consultation with experts (n = 21) to form the Medication-Related Consultation Framework (MRCF). Psychometric testing was undertaken by analyzing pharmacists' (n = 10) assessment of fifteen pre-recorded simulated consultations. Results: The MRCF consisted of 46 consultation behaviors, grouped into five sections. Performance was rated at individual behavior, framework section and global consultation levels. The MRCF discriminated between good, satisfactory and poor consultations at the global rating level (p < 0.01) with good testretest reliability (rho = 0.59-0.95) and moderate inter-assessor reliability (Kendall's W = 0.67). There was also good internal consistency for the five sections (Cronbach's alphas = 0.58-0.97). Conclusions: The MRCF demonstrated good psychometric properties at the global and section rating levels. Some inconsistencies in assessors' ratings of individual consultation behaviors were indentified, which may represent a future training need. Practice implications: The MRCF provides healthcare professionals with a patient-centered consultation structure, serving to identify medication-related needs and potentially support adherence. It also allows the quality of a practitioner's consultation to be evaluated. ß

The aim of this paper is to highlight the role of pharmaceutical care at community pharmacies in Pakistan. The paper draws on the literature related to current dispensing practices at community pharmacies in developing countries as well as in Pakistan. There are approximately 63,000 community pharmacies in Pakistan, and according to an estimate, 80% of the medicines are being distributed through this channel to majority of the population. They often lack adequate facilities, staffing and equipments. Absence of pharmacists and their roles being performed by the non-qualified personnel working at community pharmacies are a common practice. There are 8102 pharmacists who are categorized as a category, 31,000 pharmacy technicians categorized in B & C category in the country. There is a shortage of pharmacists who could be engaged for ensuring good pharmacy practices. There are only ten percent of the total pharmacists who work at community pharmacies in the country according to the Pharmacy Council of Pakistan. All kind of medicines are freely available irrespective of their status as prescription or over the counter drugs. The paper highlights that the professional role of pharmacist in hospitals and community pharmacies is switching from dispensing and sale of drugs, to patient counselling. But, the concept of pharmaceutical care at community pharmacies has not been acknowledged yet in Pakistan. The process of prescription handling is poor and patients are often treated without a proper prescription. Prescription validation, drug labeling and patient counseling are the missing components in effective patient management at the community pharmacies. The paper concludes that although laws exist, but due to lack of accountability and weak regulatory framework their proper implementation is not witnessed. Moreover, due to lack of research and evidence related to problems in dispensing practices in healthcare system of Pakistan, the counteractive actions for resolving these problems are limited.

Silva-Castro MM. Evaluación del Seguimiento Farmacoterapéutico en pacientes hospitalizados. Análisis del método Dáder y su implantación en diferentes servicios asistenciales. [Tesis Doctoral]. Universidad de Granada, 2010. 
ISBN: 978-84-693-5971-6

Introduction
Pharmaceutical care improves patients’ health by monitoring the effects of pharmaceutical treatment and reduces the costs of the treatment through medication management schemes. In Poland, there is currently no pharmaceutical care model tailored to the country’s healthcare system. In England, a wide range of pharmaceutical services covered by private schemes or by the National Health Service are available in community pharmacies; however, comparable pharmaceutical services are not currently offered in Polish community pharmacies. While British pharmaceutical education emphasises a clinical aspect to care, Polish pharmaceutical education lacks clinical emphasis. Moreover, Polish health authorities do not require the involvement of Polish pharmacists in the deployment of pharmaceutical care. As such, the aims of the present study were to survey differences in patient perception of community pharmacies in Poland and England, and to compare patients’ expectations and preferences for the existing pharmaceutical services provided in England.
Methods
A self-administered, anonymous questionnaire was distributed to pharmacy-visiting patients in England and Poland between Jan-Aug 2011. A four-page questionnaire was distributed to a number of community pharmacies in England and Poland, which were located in various villages and towns, to obtain the responses of different patient groups. The response rate of eligible participants was 55.6% (n=417/750) for 36 pharmacies in Poland and 54.0% (n=405/750) for 56 pharmacies in England. Space was provided for additional comments. Comparisons were performed using ANOVA. All statistical analyses were performed using Statistica 8.0. Ethical approval was not required for this study.
Results
Given the nature of the questionnaire, it was not surprising that the majority of the comments were negative with regard to patient satisfaction with pharmacy performance in Poland. By contrast, there was a high level of patient satisfaction in England. Altogether, n=417 individuals from 36 pharmacies in Poland (voievodships: Mazowieckie, Pomorskie, and Dolnoslaskie) and n=405 individuals from 56 pharmacies in England (Cambridgeshire, Essex, Northamptonshire, and Norfolk) completed the questionnaire and were included in the present analysis. In both Poland and England, 75% of the patients expressed high expectations for all the pharmaceutical care services detailed in our survey, including measurement of blood glucose, cholesterol, blood pressure and body weight, training in inhalation techniques and inhaler use for asthmatic patients, provision of glucometers for diabetic patients and digital blood pressure monitors for individuals with high blood pressure, and guidance on smoking cessation. In both countries, patients considered their knowledge of medicines to be either very good (Poland, 19.9%, n=83; England, 23.0%, n=93) or good (Poland, 48.9%, n=204; England, 46.9%, n=190). Differences between the responses from Poland and England were found regarding the use of the WWHAM protocol, with 65.9% (n=275) of Polish patients implying that none of the WWHAM questions had been asked by the pharmacist compared with 10.6% (n=43) of patients in England. The WWHAM protocol is not obligatory in Poland. We also found that a higher proportion of prescriptions were not filled in Poland (12.2%, n=51) versus England (1.5%, n=6). Every third Polish patient who did not fill a prescription reported that their decision was made because of financial difficulties. The analysis showed that in almost all aspects, the opinions of Polish and British patients were statistically different (p<0.05).
Discussion
Polish patients expressed a high degree of interest in all pharmaceutical services that are currently offered by community pharmacies in England, but not in Poland. The lack of a similar pharmaceutical care plan in Poland may have an impact on patient health. In particular, the WWHAM protocol is not followed in Poland. Furthermore, in Poland, patients are required to cover the full cost of filling pharmaceutical prescriptions. Changing the medication reimbursement system and offering new pharmaceutical services in Polish community
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