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Class of 2005 Abstract / Objectives: To evaluate results of a hypertension (HTN) screening provided to patients by community pharmacists at various Bashas’ United Drug Stores. Information evaluated includes risk factors for HTN and blood pressure values. Methods: This is a retrospective study analyzing results documented during clinical services provided at community pharmacies in Tucson and Phoenix, Arizona between December 2002 and January 2004. Data from 535 patients was collected. Data included risk factors (e.g. age, tobacco use, cardiovascular exercise, family history of HTN) and a blood pressure measurement by a pharmacist. For analysis, patients were separated into two groups based on HTN diagnosis status. The two groups were compared across each risk factor variable and blood pressure measurements. Results: Seven patients were excluded because they did not specify previous HTN status, leaving a total of 528 patients. Significant differences were found between the two groups regarding the following characteristics: age (p < 0.001), HTN management with drugs (p < 0.001), cardiovascular exercise (p < 0.05), family history of HTN (p < 0.001), salt intake (p < 0.001), diabetes (p < 0.001), measured systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.05). Implications: Patients with diagnosed HTN were determined to be older, more likely to receive HTN treatment, at a greater level of cardiovascular exercise, greater family history of HTN, more likely diagnosed with diabetes and had a higher systolic and diastolic measurement taken by the pharmacist when compared to the undiagnosed group.

Genital chlamydia is the most commonly diagnosed sexually transmitted infection. In August 2008, the Scottish government directed its health boards to involve community pharmacies in providing chlamydia testing and treatment for young people. Lothian Health Board envisaged a pharmacy-based chlamydia testing and treatment (CT&T) service to be able to reach deprived population. This research project set out to evaluate the implementation of the CT&T in Lothian, Scotland. However, the Lothian CT&T service suffered from setbacks such as; implementation delays, minimal advertising of the service, low uptake, withdrawal by central government of specific funding to support the service costs, and subsequent termination of the service in Lothian by March 2011. As it turned out, the CT&T service ran in Lothian for only 10 months. As events unfolded, the aims of the PhD research were successively revised so as to undertake an integrated set of studies that provide important insights and generalizable knowledge about the rationale for such a service, the process of implementation, including barriers and facilitators, and the potential to utilise routine data to assess the impact of a new service. An additional component was added, in that I undertook an analysis of an anonymous routine data on chlamydia testing obtained from the microbiology reference laboratory of Lothian to describe the epidemiology of chlamydia in Lothian (2006-2010) and to report an impact of recent policy changes (2008-2009) on chlamydia surveillance activity. Methods The Centre for Disease Control (CDC) framework for programme evaluation was used to guide design the evaluation of the CT&T service, and a subset of ‘strategic’ stakeholders for the service was involved throughout. Four studies were undertaken towards the evaluation, and these employed diverse methods, as follows: (i) A training need survey of pharmacists and their support staff was undertaken in 166 community pharmacies in Lothian, to inform the training session held prior to the CT&T service launch. (ii) A survey of 33 strategic stakeholders in Lothian was undertaken to provide input to the evaluation objectives and to identify their perceptions and concerns in relation to the CT&T initiative and its evaluation. (iii) A survey of potential service users, young people aged 15-24 years, was carried out at the Genito-Urinary Medicine (GUM) clinic and two other sexual health drop-in clinics in Lothian. The survey ascertain their preferences regarding specific aspects of the CT&T service, and their views on issues identified in previous literature as facilitators or barriers with regard to utilising of such a service. (iv) In order to understand the service provider’s perspective on setting up and delivering of the CT&T service, in-depth interviews were undertaken with participating and nonparticipating pharmacists. Eleven pharmacists were purposively sampled from 66 pharmacies invited by NHS Lothian to pilot the service roll-out. Finally, after the Lothian CT&T service had been terminated, 3 strategic stakeholders for Lothian, and a Scottish Government representative were contacted by email, to elicit their views on factors contributing to policy decisions regarding pharmacybased CT&T services. Results The analysis of disaggregated (individual) routine laboratory data showed that age, gender, year of testing and deprivation were associated with the chlamydia testing outcome measures. The before-and-after analysis, with respect to recent major policy/guidance changes (that is, publication of the sexual health service standards for Scotland in 2008, and of SIGN guidelines for chlamydia in 2009), showed that surveillance activity for chlamydia increased only transiently (i.e. in 2009 only). The annual surveillance target for women aged 15-24 years, of 300 tests / 1000 population, was achieved in 2009 only, but targets for males aged 15-24 years (of 100 tests / 1000 population) were not achieved. With respect to the evaluation studies, the training needs survey (i) had a 53% pharmacy response rate from the pharmacies comprised 41% pharmacists, 32% technicians and 26% counter assistants. The survey showed differences in selfassessed training needs between pharmacy staff groups (pharmacists/ technicians/ counter staff). With regard to pharmacist-only competencies, the highest rates of substantial training needs were for clarity regarding the medico-legal aspects (Fraser guidelines), taking a sexual history, criteria for referral and reviewing own and staff competencies for the CT&T service (83% to 77%). With respect to all staff competencies, the greatest self-reported training need was for inter-communicative aspects of providing the service – for respondents overall, 56% to 83% across competencies within this domain. For the stakeholder survey (ii), the response rate was 52% (n=17). Sixteen stakeholders indicated their strong or moderate concern regarding young peoples’ knowledge about the service. The stakeholders also acknowledged the difficulty inherent in promoting the service to those who might benefit from using it. A view commonly expressed by respondents was that sexual health counselling concomitant with testing would be difficult to deliver through the CT&T service, due to: the difficulty in achieving privacy; a busy retail environment; and pharmacists tending not to have the necessary skills. However, they also acknowledged that chlamydia service delivery is problematic everywhere and not just in pharmacies. The key benefits of the service suggested for young people included increase accessibility, normalization of chlamydia testing and its ability of provision of sexual health service to hard-to-reach population. Such a service was perceived to enhance the role of pharmacist in public health provision. The survey also sought input of strategic stakeholders to ensure that the evaluation questions of most importance to them were included. All the proposed evaluation questions were marked as important. Some suggested questions such as client’s satisfaction with the service or related to the service logistical planning could not be incorporated in the later components of the intended evaluation as the service uptake was too low to answer those questions. The survey of potential service users (iii) had an overall response rate of 20% (n=78). Young people who responded indicated that they felt confident that a pharmacy would offer complete confidentiality for testing, provide reliable test results and have knowledgeable staff to provide the service (90% to 93%). That said, these respondents indicated a preference to be tested in GUM clinic (32%) or drop-in clinics (34%), with only 11% indicating a preference for being tested in a pharmacy. Those who had not previously been tested for chlamydia placed more importance on a toilet facility in a pharmacy they would chose for chlamydia testing, whereas younger respondents (≤ 19 years) placed more importance on a less busy pharmacy. Analysis of in-depth interviews with pharmacists (iv) comprising interviews with 11 lead pharmacists (4 respondents from pilot pharmacies and 7 from non-pilot pharmacies) found that pharmacists were enthusiastic about their newly developed public health role. The respondents foresee a shift to pharmacies for being a first port of call for clients. They were also generally positive about the anticipated attitude of general practitioners and pharmacy support staff towards their provision of chlamydia service. From a pharmacist’s perspective, barriers to delivering the CT&T service were identified as workload and lack of adequate physical infrastructure within a pharmacy such as a consultation room and a toilet facility. On the other hand, the assurance of financial incentives for providing the service was a facilitator.

Class of 2008 Abstract / Objectives: The purpose of this study was to identify how community pharmacies have integrated medication therapy management (MTM) programs into their workflow and specifically determine the changes that were made in order to deliver such services. Methods: This was a descriptive study on the implementation of MTM programs in community pharmacies. Pharmacy managers associated with Cardinal Health, Medicine Shoppe International, United Drugs, the Iowa Pharmacy Association (IPA) and 10 additional selected pharmacists were invited to take an online survey regarding MTM program implementation in their pharmacy. Exclusion criteria were those pharmacists that did not provide any MTM services from January 2006 through December 2007. The primary dependent variables included time spent training, time to complete clinical pharmacy program sessions, scheduling and implementing clinical pharmacy sessions, staffing, and cost for additional equipment. Data analysis included percents and frequencies for categorical variables addressed in the internet survey. Results: Pharmacists that participated in this survey were mostly male (82%) and had been practicing for greater than 10 years. Only 3 out of 17 participants were female and all were a part of the group practicing for less than 10 years. The majority of participants in both groups completed 0-2 MTM sessions per week (p=0.65). In order to complete these sessions, the hiring of additional staff was not required (82%) nor was the purchase of additional equipment (70%). Conclusions: The implementation of MTM programs in community pharmacies requires little to no additional time or money. With this data, more pharmacists should be inclined to provide MTM sessions.

Master of Public Health - MPH / Background: The irrational use of medicines is a global public health challenge, particularly in developing countries like Nigeria. One of the consequences of irrational medicine use is rising antimicrobial resistance, which continues to contribute to the increase in morbidity, mortality, and high cost of care, despite breakthroughs in medicine and new treatment options. Community pharmacists have been identified as contributors to antimicrobial resistance through their antibiotic dispensing practices. However, there is little research on community pharmacists who provide private healthcare in Nigeria. Aim: This study described the antibiotic dispensing practices of community pharmacists and factors associated with such dispensing practices in Jos, Nigeria. Methodology: The study used a cross-sectional descriptive design. Simple random sampling was used to select a sample of 84 community pharmacies out of a total of approximately 107 community pharmacies in Jos, and one community pharmacist from each community pharmacy. A research assistant was trained to administer the questionnaire along with the researcher and collect information on community pharmacists’ demographics, antibiotic dispensing practices, and the factors associated with those dispensing practices. The socio-demographic data was analysed via descriptive analytical tools such as simple percentages and crosstabulations. These tools were used to generate a descriptive picture of the data, patterns and associations using SPSS version 25. Quantitative content analysis was done on responses to scenario-based questions, and recommendations made as to how the dispensing of antibiotics could be improved. Ethical clearance was obtained from the University of the Western Cape Biomedical Research Ethics Committee and Jos University Teaching Hospital, while informed consent was obtained from all community pharmacists before the commencement of the study. Results: The majority of the community pharmacists (87%) indicated that patients could purchase antibiotics without prescription from their pharmacies, and most pharmacists (98%) asked for reasons why antibiotics were demanded for without prescriptions. While 58% indicated that patients could purchase partial quantities of prescribed antibiotics at their pharmacies, 96% investigated the reasons for partial requests, and 94% counselled on the right dosage and frequency of the prescribed antibiotics. Sixty-seven percent of the pharmacists indicated that one of the major reasons for dispensing antibiotics without prescription was self-medication by patients, while most (87%) indicated that financial constraint was a major reason why patients requested for partial quantities of prescribed antibiotics. Conclusion: The dispensing of non-prescribed and part-prescribed antibiotics is a common practice amongst community pharmacists in Jos, Nigeria. Enhancing the financial status of Nigerians, as well as ensuring stricter regulatory measures on antibiotic use, would help promote rational use of antibiotics and reduce rising antimicrobial resistance rates.

IntroductionDepuis plusieurs décennies, la pratique et les soins pharmaceutiques sont soumis à plusieurs changements en partie en raison de l’évolution de la société, des progrès de la recherche et de la mise sur le marché de nouveaux médicaments. La pratique du pharmacien a passée d’une délivrance centrée sur le médicament vers la délivrance centrée sur le patient notamment par la détection, l’intervention et la résolution des Problèmes Liés aux Médicaments (PLM).Certains patients atteints d’une condition médicale particulière, tels que les patients cancéreux, peuvent être soumis à des traitements lourds qui leurs sont nécessaires mais qui peuvent les rendre plus vulnérable à l’apparition d’un PLMObjectifsL'objectif de cette thèse était de mettre en évidence la proportion des PLM dans les pharmacies d’officines ainsi qu’à l'hôpital et d’évaluer les potentielles conséquences en milieu hospitalier.La première partie était composée de deux projets ;1) Traduction et adaptation de la classification du PCNE V6.2 à la pratique et au cadre juridique pharmaceutique belge en intégrant la validation du contenu et la fiabilité inter-évaluateur de la classification adaptée. 2) Étude pilote visant à évaluer la proportion de PLM des antidouleurs les plus utilisés en Belgique.La deuxième partie de cette thèse était composée de trois projets. 1) Quantification et classification des réadmissions des PLM des patients cancéreux réadmis dans les 30 jours et mise en évidence des facteurs de risque liés à ces réadmissions ;2) Évaluation des coûts liés aux réadmissions dues aux PLM et les potentielles économies de PLM évitables ;3) Détection des interactions médicamenteuses à partir de différentes sources disponibles au sein de la population cancéreuse réadmise lors du premier projet et évaluation de l’impact de ces interactions sur la survie des patients.MéthodeLa classification du PCNE V6.2 a été adaptée et traduite pour le contexte belge. Afin d’évaluer la validité du contenu, les pharmaciens académiques et d’officines ont évalué six critères, deux qui ciblaient le mode d’emploi (compréhensibilité, utilité) et quatre le formulaire d’encodage (pertinence, logique d’agencement, exhaustivité et redondance). Lors de leur pratique quotidienne, les pharmaciens ont appliqué l'outil adapté du PCNE afin d’évaluer si les instructions avaient été respectées et de quantifier le temps nécessaire pour résoudre un PLM. Par la suite, l’analyse des encodages des pharmaciens a permis d’estimer la fiabilité inter-évaluateurs. Le second projet était une étude pilote qui a permis aux étudiants de Master 2 d’encoder avec l’outil adapté du PCNE V6.2 les PLM détectés en officine par leur maître de stage. Les PLM impliquant les antidouleurs ont été extraits de la base de données initiale et ont été analysés.La deuxième partie s’est basée sur une étude rétrospective observationnelle de six mois dans deux établissements de soins Bruxellois :un hôpital général universitaire et un centre de référence en oncologie. Afin d’évaluer les PLM, une revue de médication de type 2b a été appliquée pour chaque patient réadmis aux urgences ou suite à une consultation médicale. La probabilité d’implication d’un PLM dans la réadmission a été évaluée à l’aide du système du Centre de surveillance de l'organisation mondiale de la santé d'Uppsala (OMS-UMC). La réception de la base de données des différents coûts liés à ces réadmissions a permis une estimation des coûts de réadmission de ces PLM pour chacun des deux établissements impliqués. Le caractère évitable d’un PLM a pu être évalué par l’utilisation du questionnaire de Schumock et al. Le dernier projet à évaluer les potentielles interactions médicamenteuses à l'aide des bases de données en ligne Lexicomp® et Epocrates®. Une analyse de survie de Kaplan-Meier et une analyse de Cox ont été effectuées pour évaluer le lien entre les variables interaction et survenue du décès.RésultatsL'adaptation de l’outil a permis l'ajout de 16 items. Une bonne validation du contenue a été obtenue suite à l’évaluation des pharmaciens académiques et des pharmaciens d’officine. Un total de 109 PLM a été encodé, avec un temps de résolution moyen de 5 min. Concernant la fiabilité inter-évaluateur, 74 items sur un ensemble de 83 ont montré une fiabilité élevée. L’étude pilote a permis de recueillir 15 952 PLM, dont 1 832 pour les antidouleurs, 3 200 interventions ont été produites afin de résoudre les PLM. La majorité des PLM ont été totalement ou partiellement résolus (77,2%).Lors de la seconde partie de la thèse, l’analyse des dossiers de patients cancéreux réadmis dans les 30 jours a révélé que 123 patients avaient été réadmis pour un PLM certain (4,9%), probable (49,6%) ou possible (45,5%). Les facteurs de risque mis en évidence étaient un faible score de Charlson, la polymédication et certaines chimiothérapies (préparations à base de Platine, les anthracyclines ou les vinca-alcaloides). Un montant total de 495 869,10 € a été mis en évidence pour les réadmissions dues aux PLM, avec une durée médiane d’hospitalisation de 7 jours. Les cancers prédominants liés à ces réadmissions étaient le poumon (19,5%) et le sein (17,9%). En se basant sur les diagnostiques des médecins, une part importante (71,5%) des réadmissions du aux PLM était liée aux effets indésirables de la chimiothérapie.Le troisième projet de la seconde partie de ce travail a inclus une population finale de 299 patients réadmis 30 jours après la sortie de l'hôpital en raison d’un PLM. Selon les bases de données en ligne, entre 78,9% et 80,9% des patients étaient réadmis avec au moins une interaction. En moyenne entre 1,6 et 2,3 interactions par patient ont été détectés pour Lexicomp® et Epocrates®. Les opioïdes (29,9%) suivis des anxiolytiques (15,8%) étaient les médicaments les plus souvent impliqués. Les effets indésirables les plus prédominants étaient les dépressions du système nerveux central (SNC) et les dépressions respiratoires. Des analyses de Kaplan-Meier ont montré une différence statistiquement significative sur la survenue du décès, entre les patients avec et sans interactions. Néanmoins, le décès ne semble pas être directement lié à la présence d'une interaction.ConclusionLa première partie a pu montrer que l’adaptation de l’outil au contexte francophone belge était fiable et avait une validité suffisante pour une utilisation quotidienne. La participation de 6 facultés belges a permis une implication nationale permettant d’obtenir une grande proportion de PLM (15 952) ;parmi eux, plus de 10% concernaient les antidouleurs dont la quasi-totalité ont été complètement résolus.Concernant la deuxième partie, environ 10% des réadmissions de patients cancéreux dans les 30 jours suivant leur dernier soin étaient liées à un PLM, parmi ces réadmissions 71,5% étaient liées à un effet indésirable. Le coût médian par réadmission était de 2 406,10 €. Les PLM évitables représentaient 7,3% dont le coût s’élevait à un total 27 938,61 €. L’évaluation des interactions a pu mettre en évidence une forte proportion de potentielles interactions liées aux traitements de patients cancéreux, néanmoins cela ne semble pas être lié à la survenue du décès.Ce travail a pu mettre en évidence la présence importante de PLM en officine et la volonté des pharmaciens d’officines belges à améliorer leur pratique. Néanmoins l’intégration d’un outil plus spécifique à la pratique officinale sur le terrain permettrait une adhésion plus complète et potentiellement une meilleure détection. La deuxième partie de ce travail a montré quelques facteurs de risque intéressants et l’importante présence d'interactions, qui demandent une potentielle vigilance chez les patients cancéreux afin de réduire les risques de réadmission dues aux PLM et les coûts associés. Cependant, une meilleure communication entre les professionnels de santé au sein de l’hôpital mais également avec les prestataires extérieurs tels que les médecins de famille et les pharmaciens d’officine, pourrait permettre un meilleur suivi et une diminution de ces réadmissions avec pour objectif d'améliorer la qualité de vie des patients. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: the qualified practice of Dispensing is fundamental to the promotion of the rational use of medicines. Documentation is an indicator of quality and one of the essential steps in the care process. However, in Brazil there are no documentation models applicable to the practice of Dispensing. Objectives: to develop and validate an instrument to document the practice of dispensing prescribed medicines Methods: a methodological development study was carried out from February 2017 to October 2017, in two phases: (i) development of an instrument and (ii) content validation of the developed instrument. The development phase comprised three stages: (i) prototype development based on a systematic review; (ii) brainstorming and (iii) pre-Delphi. Subsequently, the validation process of the instrument content was performed through the Delphi technique. The instrument was sent to 40 experts, which all had overall experience in Dispensing, via the online platform Google Forms. The judges were instructed to evaluate the instrument according to the structure and content. Consensus was calculated using the Content Validity Index (CVI) and the items scored with CVI values >0.80. The present study was approved by the Ethics and Research Committee of the Federal University of Sergipe and all participants signed a Free and Informed Consent Term (TCLE). Results: the development stage generated three versions of the instrument: prototype; version 1 (changed after brainstorming) and version 2 (changed after pre-Delphi). In the content validation process of version 2 of the instrument, 23 experts returned their evaluation in the first round of Delphi (rate of return of 57.5%) and 17 in the second (rate of return of 73.9%). All items obtained IVC> 0.83, being considered validated. The final instrument comprised the following sections: general information, identification of technical and legal problems of prescription, conduct for the resolution of technical and legal problems of prescription, dispensed medicines, suspected drug related problem (DRP), verbal guidance, written guidance, routing and routing result. Conclusion: the instrument, developed and validated, presents the main variables that are provided in the Dispensing process. Thus, the proposed instrument can be useful to qualify this service and to improve the care process. / Introdução: a prática qualificada da Dispensação é fundamental para a promoção do uso racional de medicamentos. A documentação é um indicador de qualidade e um dos passos essenciais no processo de cuidado. No entanto, no Brasil não existem modelos de documentação aplicáveis à prática de Dispensação. Objetivos: desenvolver e validar um instrumento para documentar a prática da Dispensação de medicamentos prescritos. Métodos: foi realizado um estudo de desenvolvimento metodológico de fevereiro de 2017 a outubro de 2017, em duas fases: (i) desenvolvimento de um instrumento e (ii) validação de conteúdo o instrumento desenvolvido. A fase de desenvolvimento compreendeu três etapas: (i) desenvolvimento de protótipo baseado em uma revisão sistemática previamente realizada; (ii) brainstorming e (iii) pré-Delphi. Posteriormente foi realizado o processo de validação de conteúdo do instrumento por meio da técnica Delphi. O instrumento foi enviado a 40 especialistas, com experiência em Dispensação, no formato online, via plataforma Google Forms. Os mesmos foram instruídos a avaliarem o instrumento de acordo com a forma e o conteúdo. O consenso foi calculado por meio do Índice de validade de conteúdo (IVC) e os itens foram considerados validados com valores de IVC > 0,80. O presente estudo foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Sergipe e todos os participantes assinaram um Termo de Consentimento Livre e Esclarecido (TCLE). Resultados: na etapa de desenvolvimento foram geradas três versões do instrumento: protótipo; versão 1 (alterado após o brainstorming acadêmico) e versão 2 (alterado após o pré-Delphi). No processo de validação de conteúdo da versão 2 do instrumento, 23 especialistas retornaram sua avaliação na primeira rodada do Delphi (taxa de retorno de 57,5%) e 17 na segunda (taxa de retorno de 73,9%). Todos os itens obtiveram IVC > 0,83, sendo considerados validados. O instrumento final compreendeu as seguintes seções: informações gerais, identificação de problemas técnicos e legais da prescrição, conduta para a resolução de problemas técnicos e legais da prescrição, medicamentos dispensados, suspeita de problema relacionado ao medicamento (PRM), orientação verbal, orientação escrita, encaminhamento e resultado do encaminhamento. Conclusão: o instrumento desenvolvido e validado apresenta as principais variáveis que devem ser documentadas durante o processo da Dispensação. Assim, o instrumento proposto poderá ser uma ferramenta útil para qualificar esse serviço e aprimorar o processo de cuidado. / São Cristóvão, SE

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction. Dispensing is fundamental in patient care, since pharmaceutical counseling enables patients to receive and understand the information necessary to use medicines correctly. Although pharmaceutical counseling is a quality indicator on drug dispensing, in Brazil, protocols to guide pharmacists on this practice are scarce. Thus, research is necessary for the development and validation of instruments to support pharmaceutical counseling on dispensing prescription medicines. Objective. To develop and validate an instrument to guide pharmaceutical counseling for dispensing prescription medicines. Methods. A methodological development study was carried out from February 2017 to October 2017. The development of the instrument included the following steps: (1) elaboration of the prototype based on a previous systematic review; (2) brainstorming meeting with pharmacists, and (3) pre-Delphi. Then, the content validation of the instrument was carried out with the Delphi technique. Forty Brazilian pharmacists specialized in Dispensing were invited. They were instructed to judge the instrument, according to previously established criteria. At the end of the judgment rounds, the content validation index (CVI) was calculated. The items were considered validated if the CVI> 0.80. The present study was approved by the Ethics Committee of the Federal University of Sergipe. Results. The stages that comprised the development generated three versions of the instrument: prototype; version 1 (modified instrument after brainstorming) and version 2 (instrument modified after pre-Delphi). Version 2 of the instrument was submitted to the content validation process, in which 29 pharmacists (return rate 72,5%) made the judgment in the first round and 23 pharmacists (return rate 79,31%) in the second round. All items obtained CVI higher than 0.82 and were considered validated. Thus, the final instrument comprised three components: suggestions of questions; reasoning of the Dispensing process; and suggestions of counseling and other behaviors, being composed of 11 steps, in which each step represents a stage of clinical reasoning. Conclusion. The instrument to support pharmaceutical counseling on dispensing prescription medicines, developed based on a systematic review and validated using the Delphi technique, presents the main counseling that must be realized during that service. Thus, this instrument could support pharmacists and create referential to improve Dispensing in Brazil, in line with developed countries. / Introdução. A Dispensação é considerada uma etapa fundamental do cuidado, uma vez que a orientação farmacêutica possibilita aos pacientes receberem e compreenderem as informações necessárias para o uso correto dos medicamentos. Embora a orientação seja um indicador essencial da Dispensação, no Brasil ainda são escassos modelos e instrumentos que deem suporte à orientação farmacêutica. Objetivo. Desenvolver e validar um instrumento de suporte à orientação farmacêutica para a Dispensação de medicamentos prescritos. Métodos. Foi realizado um estudo de desenvolvimento metodológico nos meses de fevereiro de 2017 a outubro de 2017. O desenvolvimento do instrumento compreendeu as seguintes etapas: (i) elaboração do protótipo com base em revisão sistemática realizada anteriormente; (ii) reunião de brainstorming com farmacêuticos da academia e (iii) pré-Delphi. Em seguida ocorreu a validação de conteúdo do instrumento previamente elaborado, por meio da técnica Delphi. Para esta etapa, foram convidados 40 farmacêuticos especialistas em Dispensação no Brasil, os quais foram instruídos a julgar o instrumento, de acordo com critérios previamente estabelecidos. Ao final dos julgamentos, o índice de validação de conteúdo (IVC) foi calculado. Os itens foram considerados validados se o IVC > 0,80. O presente estudo foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Sergipe. Resultados. As etapas que compreenderam o desenvolvimento geraram três versões do instrumento: o protótipo; a versão 1 (instrumento modificado após o brainstorming) e a versão 2 (instrumento modificado após o pré-Delphi). A versão 2 do instrumento foi submetida ao processo de validação de conteúdo. Dos farmacêuticos convidados, 29 fizeram os julgamentos na primeira rodada (taxa de retorno 72,5%) de e destes, 23 farmacêuticos realizaram julgamentos na segunda (taxa de retorno 79,31%). Todos os itens obtiveram IVC > 0,82, sendo, portanto, considerados validados. Assim, o instrumento final compreendeu três componentes: sugestões de perguntas; raciocínio do processo de Dispensação; e, sugestões de orientações e outras condutas, e foi composto por 11 etapas, na qual cada uma representa um estágio do raciocínio clínico. Conclusão. O instrumento de suporta à orientação farmacêutica para Dispensação de medicamentos prescritos, desenvolvido com base em revisão sistemática e validado por meio da técnica Delphi, apresenta as principais orientações que devem ser realizadas durante esse serviço. Assim, essa ferramenta poderá instrumentalizar os farmacêuticos e criar referenciais para melhorar a prática da Dispensação no Brasil, em sintonia com os países desenvolvidos. / São Cristóvão, SE

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.