Can supervise: YES
Cutler, RL, Torres-Robles, A, Wiecek, E, Drake, B, Van der Linden, N, Benrimoj, SIC & Garcia-Cardenas, V 2019, 'Pharmacist-led medication non-adherence intervention: reducing the economic burden placed on the Australian health care system.', Patient Preference and Adherence, vol. 13, pp. 853-862.View/Download from: UTS OPUS or Publisher's site
Background: Scarcity of prospective medication non-adherence cost measurements for the Australian population with no directly measured estimates makes determining the burden medication non-adherence places on the Australian health care system difficult. This study aims to indirectly estimate the national cost of medication non-adherence in Australia comparing the cost prior to and following a community pharmacy-led intervention. 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 and average adherence rate determined through calculation of PDC. Included patients received a pharmacist-led medication adherence intervention and had twelve months dispensing records; six months before and six months after the intervention. The national cost estimate of medication non-adherence in hypertension, dyslipidemia and depression pre- and post-intervention was determined through utilization of disease prevalence and comorbidity, non-adherence rates and per patient disease-specific adherence-related costs. Results: The total national cost of medication non-adherence across three prevalent conditions, hypertension, dyslipidemia and depression was $10.4 billion equating to $517 per adult. Following enrollment in the pharmacist-led intervention medication non-adherence costs per adult decreased $95 saving the Australian health care system and patients $1.9 billion annually. Conclusion: In the absence of a directly measured national cost of medication non-adherence, this estimate demonstrates that pharmacists are ideally placed to improve patient adherence and reduce financial burden placed on the health care system due to non-adherence. Funding of medication adherence programs should be considered by policy and decision makers to ease the current burden and improve patient health outcomes moving forward.
Stumpf Tonin, FS, Wiecek, E, Torres Robles, AJ, Pontarolo, R, Benrimoj, SI, Fernandez-Llimos, F & Garcia Cardenas, MV 2019, 'An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis', Research in Social and Administrative Pharmacy, vol. 15, no. 4, pp. 358-365.View/Download from: UTS OPUS or Publisher's site
Poor medication adherence is associated with adverse health outcomes and higher costs of care. However, inconsistencies in the assessment of adherence are found in the literature.
To evaluate the effect of different measures of adherence in the comparative effectiveness of complex interventions to enhance patients' adherence to prescribed medications.
A systematic review with network meta-analysis was performed. Electronic searches for relevant pairwise meta-analysis including trials of interventions that aimed to improve medication adherence were performed in PubMed. Data extraction was conducted with eligible trials evaluating short-period adherence follow-up (until 3 months) using any measure of adherence: self-report, pill count, or MEMS (medication event monitoring system). To standardize the results obtained with these different measures, an overall composite measure and an objective composite measure were also calculated. Network meta-analyses for each measure of adherence were built. Rank order and surface under the cumulative ranking curve analyses (SUCRA) were performed.
Ninety-one trials were included in the network meta-analyses. The five network meta-analyses demonstrated robustness and reliability. Results obtained for all measures of adherence were similar across them and to both composite measures. For both composite measures, interventions comprising economic + technical components were the best option (90% of probability in SUCRA analysis) with statistical superiority against almost all other interventions and against standard care (odds ratio with 95% credibility interval ranging from 0.09 to 0.25 [0.02, 0.98]).
Torres Robles, A, Wiecek, E, Cutler, R, Drake, B, Benrimoj, SI, Fernandez-Llimos, F & Garcia Cardenas, M 2019, 'Using dispensing data to evaluate adherence implementation rates in community pharmacy', Frontiers in Pharmacology, vol. 10.View/Download from: UTS OPUS or Publisher's site
Wiecek, E, Tonin, FS, Torres-Robles, A, Benrimoj, SI, Fernandez-Llimos, F & Garcia-Cardenas, V 2019, 'Temporal effectiveness of interventions to improve medication adherence: A network meta-analysis.', PloS one, vol. 14, no. 3.View/Download from: UTS OPUS or Publisher's site
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...
Dineen-Griffin, S, Garcia-Cardenas, V, Rogers, K, Williams, K & Benrimoj, SI 2019, 'Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial.', JMIR research protocols, vol. 8, no. 8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. OBJECTIVE:This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. METHODS:The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes bet...
Aly, M, García-Cárdenas, V, Williams, KA & Benrimoj, SI 2019, 'A qualitative study of stakeholder views and experiences of minor ailment services in the United Kingdom.', Research in Social and Administrative Pharmacy, vol. 15, no. 5, pp. 496-504.View/Download from: UTS OPUS or Publisher's site
An international strategy designed to promote access to primary care is the utilisation of community pharmacy to deliver structured minor ailment services (MASs). An understanding of key implementation features of MASs will support effective service delivery and implementation, promote MAS viability, sustainability and overall improvement.The aim of this study is to explore the views and experiences of a range of stakeholders concerning the implementation of MASs in the United Kingdom.A qualitative approach was used to obtain data. Participants were recruited using purposeful and snowball sampling. Stakeholders from five different regions were included. Using the digital recordings of the interviews, thematic content analysis was undertaken.Thirty-three participants agreed to be interviewed. Twenty-nine semi-structured interviews were conducted. Thematic content analysis yielded three major themes, including (1) benefits of MASs, (2) structural challenges associated with MAS design and (3) other implementation factors associated with MAS delivery. Stakeholders recognised the positive impact of the service to improve patient access and care, promote efficiencies, and promote the professional role of the pharmacist. Nevertheless barriers do exist to service delivery and implementation. Stakeholders identified the need to potentially increase the population groups served by MASs, increase the conditions treated and widen their formulary lists. Similarly, marketing strategies needed to be improved to enhance consumer awareness. Stakeholders presented mixed views about whether pharmacists needed to complete clinical training and the need to increase pharmacist's remuneration. In addition the level of healthcare collaboration needed to improve.Several concepts emerged from the investigation to facilitate service delivery. Barriers to service implementation had a variable impact on implementation. Service delivery should function to meet all stakeholder needs and can be...
Dineen-Griffin, S, Garcia-Cardenas, V, Williams, K & Benrimoj, SI 2019, 'Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice.', PloS one, vol. 14, no. 8.View/Download from: UTS OPUS or Publisher's site
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...
Yong, FR, Garcia-Cardenas, V, Williams, KA & (Charlie) Benrimoj, SI 2019, 'Factors affecting community pharmacist work: A scoping review and thematic synthesis using role theory', Research in Social and Administrative Pharmacy.View/Download from: Publisher's site
© 2019 Elsevier Inc. Many community pharmacists ideologically support recent changes to their roles in primary healthcare. However, their antithetical resistance towards practice change could have systemic causes (i.e. role stresses), which may account for increased job dissatisfaction, burnout, and job turnover in the profession. Deeper comprehension was sought using a role theory framework. Objective: To identify factors leading to role stresses and strain responses for community pharmacists, and to create a framework for community pharmacist role management. Method: PubMed, Scopus and Web of Science databases were searched for qualitative studies identifying community pharmacist role stress and strain using scoping review methodology from 1990 to 2019. Content and thematic analysis using the framework method was performed, and themes were reported using thematic synthesis. Results: Screening of 10,880 records resulted in 33 studies identified, with 41 factors categorised into four domains: Interpersonal Interactions, Social Setting, Individual Attributes, and Extra-Role. All role stresses were present. Reported role strains suggest role system imbalance. Conclusion: Community pharmacists are in a multifactorial transitional environment. Reported role stresses may be a function of past pharmacist roles and increased role expectations, amplified by many requisite interactions and individual pharmacist characteristics. Social science theories were found to be applicable to the community pharmacy setting.
Cutler, RL, Van der Linden, N, Benrimoj, SIC, Fernandez-Llimos, F & Garcia-Cardenas, V 2019, 'An evidence-based model to consolidate medication adherence cost estimation: the medication adherence cost estimation framework', JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH, vol. 8, no. 8, pp. 555-567.View/Download from: UTS OPUS or Publisher's site
Ahumada-Canale, A, Quirland, C, Martinez-Mardones, FJ, Plaza-Plaza, JC, Benrimoj, S & Garcia-Cardenas, V 2019, 'Economic evaluations of pharmacist-led medication review in outpatients with hypertension, type 2 diabetes mellitus, and dyslipidaemia: a systematic review.', The European journal of health economics : HEPAC : health economics in prevention and care, vol. 20, no. 7, pp. 1103-1116.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To evaluate the health economics evidence based on randomized controlled trials of pharmacist-led medication review in pharmacotherapy managed cardiovascular disease risk factors, specifically, hypertension, type-2 diabetes mellitus and dyslipidaemia in ambulatory settings and to provide recommendations for future evaluations. METHODS:A systematic review was carried out according to the Cochrane Handbook for Systematic Reviews. PubMed (Medline), Scopus, Web of Science, National Health System Economic Evaluation Database (NHS EED), Cochrane Library, and Econlit were searched and screened by two independent authors. Incremental cost-effectiveness ratio was the main outcome. Risk of bias was assessed with the Effective Practice and Organisation of Care tool by the Cochrane Collaboration. Economic evaluation quality was assessed with the he Consensus Health Economic Criteria list (CHEC list). RESULTS:5636 records were found, and 174 were retrieved for full-text review yielding 11 articles. Eight articles deemed the intervention as cost effective and two as dominant. Two cost-utility analyses were performed yielding ICERs of $612.7 and $59.8 per QALY. Four articles were considered to perform a high-quality economic evaluation and four had a low risk of bias. Future economic evaluations should consider cost-utility analysis, to describe usual care thoroughly, and use time horizons that capture the effect of cardiovascular disease prevention, a societal perspective and uncertainty analysis. CONCLUSION:Pharmacist-led medication review has proven to be cost effective in various studies in different settings. Policy decision makers are advised to undertake local economic evaluations reflecting the gaps observed in this systematic review and published literature. If this is not possible, a transferability assessment should be conducted.
Moussa, L, Garcia Cardenas, M & Benrimoj, S 2019, 'Facilitation Strategies Used in the Implementation of Innovations in Healthcare Practice: A Systematic Review', Journal of Change Management.View/Download from: Publisher's site
Zeater, S, Benrimoj, SI, Fernandez-Llimos, F & Garcia Cardenas, MV 2019, 'A model for the financial assessment of professional services in community pharmacy: a systematic review', Journal of the American Pharmacists Association, vol. 59, no. 1, pp. 108-116.View/Download from: UTS OPUS or Publisher's site
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.
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.
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.
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.
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.
From this review, we propose a model that provides a structured approach for pharmacists to manage the finan...
Garcia Cardenas, M, Torres Robles, A, Wiecek, E, Tonin, F, Benrimoj, S & Fernandez-Llimos, F 2018, 'Comparison of Interventions to Improve Long-Term Medication Adherence Across Different Clinical Conditions: A Systematic Review With Network Meta-Analysis', Frontiers in Pharmacology, vol. 9.View/Download from: UTS OPUS or Publisher's site
Aly, M, Garcia Cardenas, MV, Williams, K & Benrimoj, S 2018, 'A review of international pharmacy-based minor ailment services and proposed service design model', Research in Social and Administrative Pharmacy, vol. 14, pp. 989-998.View/Download from: UTS OPUS or Publisher's site
Background: The need to consider sustainable healthcare solutions is essential. An innovative strategy used to promote minor ailment care is the utilisation of community pharmacists to deliver minor ailment services (MASs). Promoting higher levels of self-care can potentially reduce the strain on existing resources.
Aim: To explore the features of international MASs, including their similarities and differences, and consider the essential elements to design a MAS model.
Methods: A grey literature search strategy was completed in June 2017 to comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard. This included (1) Google/Yahoo! search engines, (2) targeted websites, and (3) contact with commissioning organisations. Executive summaries, table of contents and title pages of documents were reviewed. Key characteristics of MASs were extracted and a MAS model was developed.
Results: A total of 147 publications were included in the review. Key service elements identified included eligibility, accessibility, staff involvement, reimbursement systems. Several factors need to be considered when designing a MAS model; including contextualisation of MAS to the market.
Stakeholder engagement, service planning, governance, implementation and review have emerged as key aspects involved with a design model.
Conclusion: MASs differ in their structural parameters. Consideration of these parameters is necessary when devising MAS aims and assessing outcomes to promote sustainability and success of
Cutler, R, Fernandez-Llimos, F, Frommer, M, Benrimoj, SI & Garcia Cardenas, MV 2018, 'Economic impact of medication nonadherence by disease groups: a systematic review', BMJ Open, vol. 8, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
To determine the economic impact of medication non-adherence across multiple disease groups.
A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.
Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.
Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the co...
Crespo Gonzalez, C, Fernandez-Llimos, F, Rotta, I, Correr, CJ, Benrimoj, SI & Garcia Cardenas, MV 2018, 'Characterization of pharmacists' interventions on asthma management: a systematic review', Journal of the American Pharmacists Association, vol. 58, no. 2, pp. 210-219.View/Download from: UTS OPUS or Publisher's site
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.
A literature search was conducted in December 2016 using PubMed.
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.
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.
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.
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 ...
Garcia-Cardenas, V, Perez-Escamilla, B, Fernandez-Llimos, F & Benrimoj, SI 2018, 'The complexity of implementation factors in professional pharmacyservices', Research in Social and Administrative Pharmacy, vol. 14, no. 5, pp. 498-500.View/Download from: UTS OPUS or Publisher's site
Implementation of professional pharmacy services is a complex process, in which multi-level factors interact and influence implementation process and outcomes at various levels or domains. In this paper the terms that have been used to describe the factors that influence implementation of evidence-based services and their domains are presented. The complex 'cause-and-effect' interactions by which implementation factors appear to interact throughout the implementation process are also discussed. Identifying and understanding these complex and causal relationships between different implementation factors, represents a key process in the implementation of any service, in order to assist in the development of tailored implementation strategies. Future research should be directed to gain an understanding of the nature of individual implementation factors, their cause-and-effect interactions, and their relationships. Implementation strategies are less likely to succeed unless these are identified and targeted to the causes identified when designing and planning an implementation strategy.
Crespo-Gonzalez, C, Garcia-Cardenas, V & Benrimoj, SI 2017, 'The next phase in professional services research: From implementation to sustainability.', Research in Social and Administrative Pharmacy, vol. 13, no. 5, pp. 896-901.View/Download from: UTS OPUS or Publisher's site
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 o...
Fuller, JM, Saini, B, Bosnic-Anticevich, S, Garcia-Cardenas, V, Benrimoj, SI & Armour, C 2017, 'Testing evidence routine practice: Using an implementation framework to embed a clinically proven asthma service in Australian community pharmacy'.View/Download from: UTS OPUS or Publisher's site
Garcia-Cardenas, V, Benrimoj, SI, Ocampo, CC, Goyenechea, E, Martinez-Martinez, F & Gastelurrutia, MA 2017, 'Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report', Research in Social and Administrative Pharmacy, vol. 13, no. 3, pp. 614-627.View/Download from: UTS OPUS or Publisher's site
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.
Malet-Larrea, A, Goyenechea, E, Gastelurrutia, MA, Calvo, B, García-Cárdenas, V, Cabases, JM, Noain, A, Martínez-Martínez, F, Sabater-Hernández, D & Benrimoj, SI 2017, 'Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients.', THE EUROPEAN JOURNAL OF HEALTH ECONOMICS HEPAC HEALTH ECONOMICS IN PREVENTION AND CARE, vol. 18, no. 9, pp. 1069-1078.View/Download from: Publisher's site
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.
Noain, A, Garcia-Cardenas, V, Gastelurrutia, MA, Martinez-Martinez, F, Sabater-Hernandez, D & Benrimoj, SI 2017, 'Cost analysis for the implementation of a medication review with follow-up service in Spain', International Journal of Clinical Pharmacy.View/Download from: UTS OPUS or Publisher's site
Garcia Cardenas, MV, Armour, C, Benrimoj, SI, Martinez-Martinez, F, Rotta, I & Fernandez-Llimos, F 2016, 'Pharmacists' interventions on clinical asthma outcomes: a systematic review', European Respiratory Journal, vol. 47, pp. 1134-1143.View/Download from: UTS OPUS or Publisher's site
The objective of this systematic review was to evaluate the impact of pharmacists' interventions on clinical asthma outcomes on adult patients and to identify the outcome indicators used.
PubMed, Scopus, Web of Science and Scielo were searched. Studies addressing pharmacists' interventions on adult asthma patients reporting clinical asthma outcomes were incorporated.
11 clinical outcomes were identified in 21 studies. 10 studies measured the impact of the intervention on asthma control. Randomised controlled trials (RCT) and non-RCTs found positive results in percentages of controlled patients and Asthma Control Questionnaire (ACQ) scores. Discordant results were found for Asthma Control Test results. Asthma severity was assessed in four studies. One RCT found a significant decrease in the percentage of severe patients; two non-RCTs found significant improvements in severity scores. 11 studies reported pulmonary function indicators, showing inconsistent results. Eight studies measured asthma symptoms; three RCTs and four non-RCTs showed significant improvements.
RCTs and non-RCTs generated similar results for most outcomes. Based on the evidence generated by RCTs, pharmacists' have a positive impact on the percentage of controlled patients, ACQ scores, severity and symptoms. Future research should report using the core outcome set of indicators established for asthma (PROSPERO CRD42014007019).
Malet-Larrea, A, Garcia-Cardenas, V, Saez-Benito, L, Benrimoj, SI, Calvo, B & Goyenechea, E 2016, 'Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review.', Expert Review of Pharmacoeconomics and Outcomes Research, vol. 16, no. 6, pp. 747-758.View/Download from: UTS OPUS or Publisher's site
Introduction: The aim was to determine whether professional pharmacy services (PPS) provided to ambulatory patients attending community pharmacy are cost-effective compared with usual care (UC).
Areas covered: MEDLINE, Web of Knowledge, Scopus, Cochrane Library and Centre for Reviews and Dissemination databases were searched, and the risk of bias of randomized controlled trials, and the methodological quality of economic evaluations was assessed. A total of 17 economic evaluations of 13 studies were included. Seven studies were classified as high-, three as medium- and three as low-quality. PPS were more effective and less costly than UC in four studies; seven studies concluded that PPS were more effective and more costly and two studies concluded that the service was as effective as the UC, with higher and lower costs.
Expert commentary: Although the uncertainty was variable among the studies, a general trend towards the cost-effectiveness of PPS was observed. Decision makers are encouraged to consider the feasibility of implementing PPS.
Malet-Larrea, A, Goyenechea, E, García-Cárdenas, V, Calvo, B, Arteche, JM, Aranegui, P, Zubeldia, JJ, Gastelurrutia, MA, Martinez-Martinez, F & Benrimoj, SI 2016, 'The impact of a Medication Review with Follow-up service on hospital admissions in aged polypharmacy patients', British Journal of Clinical Pharmacology, vol. 82, no. 3, pp. 831-838.View/Download from: UTS OPUS or Publisher's site
Romero-Sanchez, J, Garcia-Cardenas, V, Abaurre, R, Martinez-Martinez, F & Garcia-Delgado, P 2016, 'Prevalence and predictors of inadequate patient medication knowledge', Journal of Evaluation in Clinical Practice, vol. 22, pp. 808-815.View/Download from: UTS OPUS or Publisher's site
Objectives To assess medication knowledge in adult patients and to explore its determi-nants.Method Cross-sectional study. Medication knowledge was the primary outcome and wasassessed using a previously validated questionnaire. A multivariate logistic regression anal-ysis was performed to explore the association between medication knowledge and thefactors included in the model.Results Seven thousand two hundred seventy-eight patients participated in the study.71.9% (n = 5234) (95% CI: 70.9%–73.0%) of the surveyed patients had an inadequateknowledge of the medication they were taking. The dimensions obtaining the highest levelof knowledge were the 'medication use process' and 'therapeutic objective of medication'.The items 'frequency' (75.4%), 'dosage' (74.5%) and 'indication' (70.5%) had the highestpercentage of knowledge. Conversely, 'medication safety' represented the dimension withthe lowest scores, ranging from 12.6% in the item 'contraindications' to 15.3% in the item'side effects'. The odds ratio (OR) of having an inadequate medication knowledge in-creased for unskilled workers (OR: 1.33; 85% CI:1.00–1.78; P = 0.050), caregivers(OR:1.46; 95% CI:1.18–1.81; P < 0.001), patients using more than one medication (OR:1.14; 95% CI: 1.00–1.31; P = 0.050) and patients who did not know the name of the med-ication they were taking (OR: 2.14, 95% CI: 1.71–2.68 P < 0.001).Conclusion Nearly three quarters of the analysed patients had inadequate knowledgeregarding the medicines they were taking. Unskilled workers and caregivers were at ahigher risk of lacking of medication knowledge. Other factors that correlated with inade-quate medication knowledge were the use of more than one drug and not knowing the nameof the medication dispensed.
Garcia-Cardenas, V, Castrillon Ocampo, C, Martinez-Martinez, F, Benrimoj, SI, Amariles, P & Gastelurrutia, MA 2015, 'Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes', International Journal of Clinical Pharmacy, vol. 37, no. 5, pp. 931-940.View/Download from: UTS OPUS or Publisher's site
Background Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy. Objective The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation. Setting Community pharmacies in Spain. Method The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service. Main outcome measure Economic, clinical, and humanistic measures were used to assess the impact of the service. Results 132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95 % = 0.10–0.99)] and in emergency department visits [OR = 0.16 (IC 95 % = 0.05–0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5 %) were non-adherent to ...
Hernández, A, Garcia-Delgado, P, Garcia-Cardenas, V, Ocaña, A, Labrador, E, Orera, ML & Martinez-Martinez, F 2015, 'Characterization of patients' requests and pharmacists' professional practice in oropharyngeal condition in Spain', International Journal of Clinical Pharmacy, vol. 37, no. 2, pp. 300-309.View/Download from: UTS OPUS or Publisher's site
Background A sore throat is the reason behind 4 million visits to health care services per year in Spain. The management of these ailments is usually associated with an inappropriate use of medicines. Community pharmacists are often the first point of contact for patients under the healthcare system and play a major role in the management of minor ailments. Objective To characterize the pharmacists' professional practice in oropharyngeal condition in terms of patients' requests and pharmacists' interventions performed. Setting Community pharmacies throughout Spanish territory. Method Cross-sectional multicenter observational study, undertaken between November 2012 and March 2013. Patients were recruited consecutively in the participant pharmacies. Eligible patients were those making a consultation related to an oropharyngeal condition or requesting treatment for an oropharyngeal condition. A univariate descriptive analysis showing the frequency of occurrence of the different variables was performed. This was completed with a multivariate statistical analysis through a multiple correspondence method, in order to analyze the potential association between the pharmacist profile and the intervention provided. Main outcome measure Professional Pharmacy Service requested (dispensing/counselling/medication review with follow-up), reason for consultation, source of the recommendation, Pharmacist's intervention and reason for referral. Results 710 pharmacies and 3,547 patients participated in the study. The most frequently requested service was dispensing (44.7 %), followed by counselling (31.8 %). Regarding dispensing, the majority of patients requested a throat preparation, mostly antiseptics. Symptoms associated with the pharmacy consultation were mainly throat symptoms (70.8 %), voice symptoms (24.9 %), and mouth/tongue/lip symptoms (10.1 %). The most common pharmacist intervention was 'selection of pharmacological treatment', followed by 'dispensing the requested med...
Jodar-Sanchez F, Malet-Larrea A, Martin JJ, Garcia-Monchon L, Lopez del Amo MP, Martinez-Martinez F, Gastelurrutia-Garralda MA, Garcia-Cardenas V, Sabater Hernandez, D, Saez-Benito L & Benrimoj, SI 2015, 'Cost-Utility Analysis of a Medication Review with Follow-Up Service for Older Adults with Polypharmacy in Community Pharmacies in Spain: The conSIGUE Program', PharmacoEconomics.View/Download from: UTS OPUS or Publisher's site
Jodar-Sanchez, I, Malet-Larrea, A, Martin, J, Garcia, L, Lopez del Amo, MP, Martinez-Martinez, F, Gastelurrutia-Garralda, MA, Garcia-Cardenas, M, Sabater-Hernandez, D & Benrimoj, S 2014, 'COST-UTILITY ANALYSIS OF A MEDICATION REVIEW WITH FOLLOW-UP FOR OLDER PEOPLE WITH POLYPHARMACY IN COMMUNITY PHARMACIES IN SPAIN: CONSIGUE PROGRAM', VALUE IN HEALTH, vol. 17, no. 7, pp. A511-A512.View/Download from: Publisher's site
Perez-Escamilla, B, Garcia Cardenas, V, Gastelurrutia, MA, Varas, R, Saez-Benito, L, Martinez-Martinez, F & Benrimoj, C 2014, 'Percepcion de los formadores colegiales sobre el futuro profesional de esta nueva figura laboral en la farmacia comunitaria [Perception of Practice Change Facilitators on the professional future of this new job in community pharmacy]', Pharmaceutical Care Espana, vol. 16, no. 3, pp. 81-88.View/Download from: UTS OPUS
Garcia-Cardenas, V, Sabater Hernandez, D, Kenny, PM, Martinez-Martinez, F, Faus, MJ & Benrimoj, C 2013, 'Effect of a pharmacist intervention on asthma control. A cluster randomised trial', Respiratory Medicine, vol. 107, no. 9, pp. 1346-1355.View/Download from: UTS OPUS or Publisher's site
Achievement and maintenance of good asthma control is a major objective in asthma management. However, asthma control in many patients is suboptimal, due to improper use of asthma medications and non-adherence. The aim of this study was to evaluate the effect of a pharmacist intervention on asthma control in adult patients. Methods A 6-month cluster randomized controlled trial was undertaken with allocation of community pharmacies to intervention or control group. Adult asthma patients in the intervention group received a protocol-based intervention addressing individual needs related to asthma control, inhaler technique and medication adherence. Patients in the control group received usual care. Main variables were measured at baseline, 3 and 6 months. Results 336 patients completed the study, 150 in the control group and 186 in the intervention group. The intervention resulted in enhanced asthma control: Patients receiving the intervention had an Odds ratio of 3.06 (95% CI:1.635.73; p < 0.001) of having controlled asthma six months later. In the intervention group mean ACQ scores significantly improved [0.66 points (SD: 0.78); p < 0.001] and the number of controlled asthma patients increased by 30.1% (p < 0.001) after 6 months. The intervention also resulted in improved medication adherence (by 40.3%, p < 0.001) and inhaler technique (by 56.2%, p < 0.001). No significant changes for any of these variables were observed in the control group.
Martínez-Martínez, F, García-Cárdenas, V, Fikri-Benbrahim, N, García-Delgado, P & Faus, MJ 2013, 'Virtual design for a patient training and practice of care pharmaceutica', Vitae, vol. 20, no. SUPPL. 1.
Martínez-Martínez, F, García-Cárdenas, V, Sáez-Benito, L, Varas, R, Ángel Gastelurrutia, M, Sabater Hernandez, D, José Faus, M & Benrimoj, SI 2013, 'Get Impact Program. Evaluation clinical impact, economic and humanistic Pharmacotherapy follow adults greater polypharmacy', Vitae, vol. 20, no. SUPPL. 1.
Benrimoj, C, Garcia-cardenas, V, Gastelurrutia, A & Faus, MJ 2012, 'Factors affecting community pharmacists' participation in a Pharmaceutical care service for asthmatic patients', Pharmaceutical Care Espana, vol. NA, pp. 19-27.
Objective: Identify trough the PRECEDE model those factors predisposing, reinforcing and enabling the participation of a group of pharmacists in the AFasma project. Methods: Qualitative study through semi-structured interviews and participant observation of the pharmacists included in the intervention group of the AFasma project. Results: Predisposing factors motivating the pharmacist were: asthma training, professional satisfaction, patient loyalty and increase pharmacy value. Those desmotivating were: lack of time, lack of physician-pharmacist collaborative working relationship, lack of staff and marketing and diffi culties in offering the service. Facilitating factors were: pharmacist-patient communication skills, ability to complete data forms, correct inhaler technique and payment for the service. In contrast, there was a lack of skills to offer the service to the patient, lack of a patient counseling area, doubts with the inhaler technique assessment and asthma non-pharmacological advice, and pharmacy staff not working as a team. Reinforcing factors supporting the service were: professional and personal satisfaction, improvement of the pharmacist-patient relationship, pharmacology training. The reinforcing factor against the service was the time spent during the project. Conclusions: Using the PRECEDE model we were able to identify the factors predisposing, facilitating and enabling the participation of a group of pharmacist in the AFasma project. With the factors identifi ed a number of strategies could be developed in order to support further studies and facilitate a potential implementation of the service
Garcia-cardenas, V, Sabater Hernandez, D, Garcia-corpas, J, Faus, M, Martinez-martinez, F & Benrimoj, C 2012, 'Errors In Turbuhaler Technique In A Spanish Population Of Asthmatic Patients', Respiratory Care, vol. 57, no. 5, pp. 817-818.View/Download from: Publisher's site
Pintor-Marmol, A, Baena, MI, Fajardo, PC, Sabater Hernandez, D, Saez-Benito, L, Garcia-Cardenas, M, Fikri-Benbrahim, N, Azpilicueta, I & Faus, MJ 2012, 'Terms used in patient safety related to medication: a literature review', Pharmacoepidemiology and Drug Safety, vol. 21, pp. 799-809.View/Download from: UTS OPUS or Publisher's site
Purpose There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature. Methods Original and review articles that were indexed between 1998 and 2008 in MEDLINE and EMBASE and contained terms used in patient safety related to medication were included. Terms and definitions were extracted and categorised according to whether its definition referred to the process of medication use, or to the clinical outcome of medication use, or both. Results Of 2564 articles, 147 were included. Sixty terms used in patient safety related to medication with 189 different definitions were identified. Among terms that referred only to the process of medication use (n = 23), medication error provided the greatest number of definitions (n = 29). Among terms that referred only to the clinical outcome of medication use (n=31), adverse drug event provided the greatest number of definitions (n = 15). Finally, among terms that referred both to the process of use and to the clinical outcome of medication use (n = 13), drug-related problem provided the greatest number of definitions (n=7). Conclusions A multitude of terms and definitions are used in patient safety related to medication. This heterogeneity makes it difficult to compare the results among studies and to appreciate the true magnitude of the problem. Classifying and unifying the terminology is necessary to advance in patient safety strategies.
Sabater Hernandez, D, Faus, MJ, Fikri-Benbrahim, N & Garcia-Cardenas, V 2010, 'Resultados globales de la base de datos del Programa Dader de Seguimiento Farmacoterapeutico: 2008', Atencion Primaria, vol. 42, no. 5, pp. 297-304.
Sabater Hernandez, D, Faus, MJ, Fikri-Benbrahim, N & García-Cárdenas, V 2010, 'Overall results of the Dader Pharmacotherapeutic Follow-Up Program data base: 2008', Atencion Primaria, vol. 42, no. 5, pp. 297-298.View/Download from: Publisher's site
Fikri-Benbrahim, N, García-Cárdenas, V, Sáez-Benito, L, Gastelurrutia, MA & Faus, MJ 2009, 'Adherence: A review of education, research, practice and policy in Spain', Pharmacy Practice, vol. 7, no. 3, pp. 125-138.View/Download from: Publisher's site
Aims: To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade. Methods: A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites. Results: Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional. Conclusions: At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future.
Garcia Cardenas, M, Rossing, C & Benrimoj, S 2019, 'Pharmaceutical Care and implementation strategies' in The Pharmacist Guide to Implementing Pharmaceutical Care, Springer, Germany, pp. 203-212.View/Download from: UTS OPUS or Publisher's site
Implementation of pharmaceutical care through professional pharmacy services is a complex process, in which multilevel implementation factors interact and affect implementation processes and outcomes. This process has traditionally been approached in an ad hoc manner, and assuming that positive benefits and diffusion of information through key stakeholders would ensure the service's integration into routine practice. It is now known that this traditional approach is not sufficient to effectively integrate innovations into routine practice of pharmacy, and that more complex, tailored, and evidence-based approaches are needed. The application of implementation science to the implementation of professional pharmacy services will facilitate this complex process and will assist in ensuring their long-term sustainability.
Rossing, C, Benrimoj, SI & Garcia Cardenas, M 2019, 'Implementation of Pharmaceutical Care in Community Setting' in The Pharmacist Guide to Implementing Pharmaceutical Care, Springer, Germany, pp. 213-222.View/Download from: Publisher's site
Pharmaceutical care services in primary care have been an area of research from the initial definitions in the early 1990s. The research has resulted in a range of evidence-based services delivered in primary care setting, from the community pharmacies and by the pharmacy workforce. Research has also been focusing on the implementation in community pharmacy practice, taking into account the change in perception of the pharmacy that is needed to deliver pharmaceutical care services. In many countries, pharmaceutical care services are remunerated and to a some extent are delivered to the public, although there is still an implementation gap between what is the potential of service delivery and what is actually delivered. The services are implemented in primary care, primarily delivered by the community pharmacy confirming the role of the community pharmacy in the primary healthcare system.