Portuguese Community Pharmacies Research Articles

Physical activity promotion in the community pharmacy: An opportunity for an expanded role?

BackgroundPhysical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists’ role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice. ObjectiveThe aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion. MethodsIn-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion. ResultsData saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 – Knowledge, #10 – Memory, Attention and Decision Processes and #13 – Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP. ConclusionCommunity pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.

Role of Portuguese community pharmacy and pharmacists in self-care

Portugal recognizes the importance of self-care in its policies and has been actively engaging in health literacy and citizen empowerment. The current National Health Plan for the period 2021–2030 clearly mentions the need to “take greater advantage of the network of community pharmacies throughout the national territory, in favour of the health of the community, from the protection and promotion of health, through health literacy, to the prevention and early detection of disease, and the aggravation of chronic disease, among others”. There is recognition of the role of pharmacists and community pharmacies. However, more needs to be done to promote intersectoral collaboration, particularly as community pharmacies are private entities but can nonetheless support the public national health service. Community pharmacies assisted many individuals during the pandemic to test suspect cases free of charge. The fight to end AIDS and viral hepatitis is another example where community pharmacies promote self-testing and ensure efficient screening and referral to diagnosis and treatment. Portugal has already moved to reimburse community pharmacies for services with some of them in areas of self-care including COVID-19 testing. Nevertheless, future challenges include making community pharmacies sustainable. Taking into account that community pharmacies are private entities that can supplement the public health service just as any other provider, it is essential to review payment models, referral mechanisms and access and integration of information from other partners in primary and secondary care.

CO125 Characteristics of Asthma Patients at GINA's Higher Steps on OCS Treatment: A Cross-Sectional Study in Portuguese Community Pharmacies (EmOCS Study)

To describe sociodemographic and clinical characteristics, treatment regimen, asthma-related healthcare resources utilization (HCRU), and disease control of asthma patients at GINA’s steps 3 to 5; and compare patients according to OCS use.

Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies.

Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA). Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®). A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users). These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.

PHARMACOTHERAPY IN THE OLDER ADULT: CHARACTERIZATION, MEDICATION ADHERENCE AND POTENTIALLY INAPPROPRIATE MEDICATIONS

Introduction: Aging is a dynamic process in which biochemical and physiological changes are related to a higher frequency of pathological processes, which ultimately lead the human being to death. Part of these alterations and pathologies are improved using medicines, so older adults are great consumers of medicines. Several instruments have been used to evaluate the use of inappropriate medications in older adults, with Beers Criteria frequently used. The concept of medication adherence has undergone changes over time and represents the degree to which the patient’s behaviour corresponds and agrees with the recommendations of a doctor or other health professional. Medication non-adherence to entails a decrease in the quality of life of the patients and high costs for the health systems. Objectives: To characterize drug therapy in older adult users of a northern Portuguese community pharmacy, as well as to identify the presence of potentially inappropriate medications (PIMs) in the older adult and to assess medication adherence. Methods: Exploratory and descriptive study. The target population was older adult users of a community pharmacy in the municipality of Valpaços, Portugal. The data collection instrument used was a questionnaire applied in the form of a structured interview. The potentially inappropriate medications (PIMs) identification was based on the most recent version of the Beers Criteria published in 2019. The MAT (Measurement of Adherence to Treatments) scale was used to evaluate medication adherence. The statistical treatment included the calculation of absolute and relative frequencies, measures of central tendency and dispersion. Results: 60 older adult people were interviewed, 53.3% of them women. The average age was 78.35 years. Among these, 55.0% were married/had a non-marital partner, 71.7% lived accompanied, 26.7% had primary school education, 40.0% received less than 300 Euros monthly and 95.0% lived in the municipality of Valpaços. Each older adult person consumes on average 6 different types of medication per day. Major polymerization was present in 66.7% of older adults, and 94.2% of the drugs being prescribed by the physician. In 34.7% of the cases, the medication had been used for at least 1 year and only 3.4% reported feeling adverse reactions. Of the total 326 drugs identified, the most prescribed pharmacotherapeutic groups were drugs acting in the cardiovascular system 27.2% and in the digestive system 24.2%. Additionally, 15 drugs classified as potentially inappropriate medication were identified in the older adult. Most of the older adults (76.7%) did not adhere to drug therapy, these being mainly females with primary education, living with a partner and less than 300 euros/month. Conclusion: Polymedication and the use of potentially inappropriate medications are common in older adults. Medication adherence is low.

Evaluation of Cardiovascular Pharmacotherapy Guideline Adherence and Risk Factor Control in Portuguese Community Pharmacy Patients.

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Assessing the patients’ CVD risk, controlling the risk factors, and ensuring the guideline-adherent cardiovascular pharmacotherapy are crucial interventions to improve health outcomes. This study aimed to evaluate the potential of pharmacists to improve the adherence to pharmacotherapy guidelines and the achievement of risk factor goals among patients who attended a community pharmacy. Methods: We conducted a single-center cross-sectional study. We performed in-pharmacy point-of-care testing, blood pressure and anthropometric measurements, and reviewed patients’ pharmacotherapy, based on European Society of Cardiology guidelines. Results: Of the 333 patients, 63.1% were in the high/very high risk category, 91.9% showed at least two modifiable risk factors, and in 61.9% of patients the cardiovascular pharmacotherapy was non-adherent to the current guidelines, failing to reach treatment goals. The lipid-lowering therapy was the least guideline adherent, with a suboptimal use of statins. However, we found no statistically significant difference between the guideline-adherent and the non-adherent group in terms of risk factor control. The pharmacist recommended 603 interventions to adhere to the guidelines. Conclusions: Community pharmacists are able to identify opportunities to optimize cardiovascular pharmacotherapy and support the patients to achieve cardiovascular risk factor goals, based on evidence-based guidelines, contributing to the improvement of CVD management.

POSC211 Effects of the Policy Regulation on Generic Competition and Pharmaceutical Savings in Portugal. Do Incentives Matter?

Considering generics incentive schemes worldwide and Portuguese pharmaceutical market and trends, this study aims to measure the impact of generic incentives system introduced in January 2017 in Portugal, in terms of market share, prices and expenditure savings (real and potential) for the different stakeholders (NHS, patients and pharmacies). We conducted a before-and-after study, analyzed outpatient market indicators, and estimated savings under the incentive system of cheaper medicines dispensing based on the difference between prices for each group of the internal Reference Price (RP) System. The database included sales from Portuguese community pharmacies and drugs prescription panel data from January 2014 to December 2020. The statistical analysis of monthly data by product was performed with Statistical Analysis System (SAS), version 8.2. Since 2017, significant changes were observed: generic market share stopped the downward trend, and the average price of drugs start rising. Medicines with the lower prices increased their market share from 35.2% in 2017 to 38.0% in 2020. In 4 years, the implemented generics incentives system generated 36.5M€ of savings for NHS, while the overall expenditure savings were 1,511M€ with generic dispensing. Pharmacies were reimbursed by 28.2M€ through this system. The system generated savings for the NHS, incentivizing cheaper medicines dispensing, lowering the RP and counteracting the downward trend on generics’ market share. However, this scheme ignores NHS gains when dispensing medications below the RP, and the cumulative effects in subsequent periods when considering only the RP transition period, with an underestimation of the real benefits. Additionally, it includes a risk-sharing based only on a clawback from pharmacies to the NHS, not redistributing when savings are greater than the incentives paid. Therefore, future policies should explore additional savings that still exists for the health system and patients, contributing to higher accessibility to medicines and therapeutic adherence.

Drug shortages in community pharmacies: Impact on patients and on the health system

BackgroundWorldwide, drug shortages are a critical public health concern. Consequences range from inconvenience and distress to more serious concerns related to negative clinical, humanistic and economic outcomes. ObjectiveThis study aimed to investigate the impact of drug shortages at the community pharmacies on patients and on the health system in Portugal. MethodsA national, cross-sectional, multicenter study was conducted in Portuguese community pharmacies during April 2019. The proportion of patients reporting drug shortages, types of drugs affected and consequent economic burden to patients and the health system were estimated. Regional and urban setting stratification was performed. ResultsA total of 71.1% of pharmacies participated in the study and 22,830 patient surveys were retrieved. About 52.2% of patients experienced a drug shortage in the past 12 months; 21.5% had to see a physician to change the prescription and 5.7% declared treatment discontinuation because of this shortage. The estimated economic impact of shortages related to additional physician appointments varied between €2.1-€4.4 million for patients and €35.3-€43.8 million for the National Health Service. Drug shortages were mostly felt in rural and inner regions and least felt in the islands. ConclusionThis national study showed that community pharmacy drug shortages are a national problem with negative consequences on patients and the health system, which need to be tackled and mitigated.

Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy

Background: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists’ interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. Methods: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. Results: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). Conclusions: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.

Characteristics of Reliever Inhaler Users and Asthma Control: A Cross-Sectional Multicenter Study in Portuguese Community Pharmacies.

PurposeSABA overuse might indicate poorly managed or uncontrolled asthma and be responsible for poor health outcomes. The aim of this study integrated in new fourth multi-design SABINA+ pillar was to characterize the population using short-acting β2-agonists for asthma and examine the patterns of its use among community pharmacy customers in Portugal, as well as identify characteristics associated with disease control and explore potential differences between GINA treatment steps.Patients and MethodsThis cross-sectional multicenter study was conducted in Portuguese community pharmacies between 29 May 2018 and 15 August 2018. Participants were adults (age ≥18 years) self-reporting asthma diagnosis recruited in the context of a short-acting β2-agonist dispense. A two-part questionnaire (pharmacist interview and self-administered) was used to collect information about sociodemographic characteristics, comorbidities, reliever inhaler use, healthcare resource consumption and self-reported disease control (assessed by the Control of Allergic Rhinitis and Asthma Test – CARAT®). Descriptive statistics was done to characterize the study sample. After categorizing patients according to GINA steps, based on their therapeutic regimen, we performed an exploratory subgroup analysis to evaluate if there were any differences between such groups in terms of the variables collected. A logistic regression was used to identify the potential determinants of overall disease control.ResultsAround 50.8% of patients were male, and the average age was 52 years old. Half of the patients never smoked, and 51.9% were employed. More than half of the patients report inhaler overreliance – purchasing more than 1 pack in 3 months (65.0%) or using the inhaler on more than 8 days over the previous 4 weeks (50.2%). Of the total number of patients in the study, 79.1% had poorly controlled asthma symptoms, and 78.7% had overall poorly controlled respiratory symptoms. We found statistically significant differences between GINA treatment steps in all sociodemographic characteristics (sex, mean age, education level, employment status); maximum number of SABA uses in 24h, CARAT score (total an asthma sub-score); history of exacerbations requiring ED visits or treatment with OCS for at least 3 days in the previous 12 months. Logistic regression revealed that patients reporting SABA use in more than 8 days in the previous 4 weeks and patients with at least 1 exacerbation requiring treatment with OCS for at least 3 days in the previous 12 months have greater odds of poor disease control [adjusted OR (95% CI): 2.6 (1.3–5.2) and 3.0 (1.3–6.6)].ConclusionBased on the results of this study, it can be inferred that the asthma population using SABA is largely uncontrolled and uses reliever inhalers excessively.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies.

Background:Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.Objective:To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.Methods:A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.Results:Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.Conclusions:We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

Physical activity promotion in community pharmacies: pharmacists' attitudes and behaviours.

Background:Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active.Objective:This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice.Methods:A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies.Results:In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3).Conclusions:Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.

Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study

BackgroundIn 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants’ expectations regarding services and counselling.MethodsThis was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019.ResultsApproximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse.ConclusionThis study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants’ perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.

Exploring pharmacists’ orientation towards patients in Portuguese community pharmacies

ABSTRACT Background: Patient-centered care has been associated with improved patient outcomes and healthcare satisfaction. The present study aimed to explore pharmacy practitioners’ orientation to patients in daily work, as well as job satisfaction as a possible associated factor. Methods: A cross-sectional survey of a sample of Portuguese community pharmacists was used for gathering participants’ demographics, professional and work-related data, self-perceived level of technical and relational competences, and the importance ascribed to these skills. The Portuguese version of the Patient-Practitioner Orientation Scale (PPOS) and a Portuguese reduced version of a Healthcare Job Satisfaction Scale completed the on-line questionnaire. Results: A sample of 274 respondents comprised 81.1% females, with a mean age of 37.2 years, 11.6 years of work experience on average, and subject to a work intensity of 5.36 clients per hour, mainly for counter dispensing (73.0%). Overall, technical competences were significantly more important than relational ones, but practitioners with fewer experience self-perceived as weaker in communication competences. Females scored higher in relational competences importance as well as in PPOS (p < 0.05). No significant difference in PPOS was found between pharmacists with more and less direct interaction with patients, but higher when performing consultation services (p < 0.05). Conclusions: The existing orientation to patients seems to be under the desired levels and independent of community pharmacists’ work intensity, nevertheless linked with work experience and differentiated patient services. Although professionals might recognize the importance of relational competencies to provide patient-centered care and achieve better outcomes, it is essential to promote clinical training amongst community pharmacists.

PCV143 SACUBITRIL/VALSARTAN PRESCRIPTION PATTERNS AND TITRATION IN A REAL-WORLD SETTING IN PORTUGAL: AN ANALYSIS OF THE PRIME STUDY

Sacubitril/valsartan is indicated in adult patients with symptomatic heart failure with reduced ejection fraction. According to its posology, dose should be doubled at 2-4 weeks to the target dose. However, previous real-world studies have reported slow titration schemes. The objective of this analysis was to evaluate sacubitril/valsartan prescription and titration patterns in a real-world setting in Portugal. The PRiMe study is a cross-sectional and multicenter study. Adult patients (≥18 years) or caregivers with a prescription (initial or refill) of sacubitril/valsartan were recruited through Portuguese community pharmacies. A structured questionnaire was applied to collect data directly from the patients or caregivers with support from a trained pharmacist. Additional data were collected through the pharmacy’s software and patient’s echocardiogram report. As of May 2019, 262 eligible patients (27.6% starting sacubitril/valsartan for the first time) were recruited. The first prescription of sacubitril/valsartan was in 82.3% of the patients filled in by a cardiologist, 9.3% by a general practitioner (GP) and 6.8% by an internist. In the majority of cases (72.9%), sacubitril/valsartan initiation started after a programmed medical appointment and in 25.9% after an emergency/hospitalization episode. Among refills, cardiologists were responsible for 48.1% of refills, GPs for 36.1% and internists for 12.8%. A total of 42.1%, 32.4% and 6.0% of the patients started sacubitril/valsartan 24 mg/26 mg, 49 mg/51 mg and 97 mg/103 mg, twice daily, respectively. After a mean time of 4.9 months (SD=3.9) of sacubitril/valsartan treatment, 31.3% were taking the 24 mg/26 mg dose, 36.5% the 49 mg/51 mg dose and 17.4% the 97 mg/103 mg dose, twice daily. A total of 60.9% patients did not change doses while 31.3% had at least one uptitration. In a real-world setting, the uptitration of sacubitril/valsartan is slow, if considered a mean of five months treatment with sacubitril/valsartan.

PCV150 - HEALTH CARE RESOURCE USE AND QUALITY OF LIFE IN PATIENTS PRESCRIBED WITH SACUBITRIL/VALSARTAN IN PORTUGAL: A CROSS-SECTIONAL OBSERVATIONAL STUDY (PRIME STUDY)

To assess the quality of life (QoL) and health care resource utilization of patients being prescribed with sacubitril/valsartan in Portugal. The PRiMe study is an observational, cross-sectional and multicenter study. Patients or caregivers with a prescription (initial or refill) of sacubitril/valsartan are being recruited through Portuguese community pharmacies. All community pharmacies associated with the Portuguese National Association of Pharmacies (∼2,500) were invited to participate. Data is being collected through a structured two-part questionnaire. The first part is delivered by a trained pharmacist and the second part is filled in by the patient, where the patient-reported outcomes’ (PRO) data is being collected. QoL is being measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the EQ-5D-3L. Data on resource use are being evaluated by the number of emergency room visits, hospitalizations and doctors’ appointments related with heart failure/cardiovascular diseases within the last 12 months. This study was approved by the competent Ethics Committee and is compliant with the General Data Protection Regulation. Currently, 328 pharmacies accepted to participate in the study. Regional and setting (urban/sub-urban/rural) distribution of participating pharmacies is similar (p>0.05) to the universe of community pharmacies, ensuring national representativeness. Final summary scores of MLHFQ and EQ-5D-3L as well as health care resources consumption will be available by September’18. Sacubitril/valsartan is approved for the treatment of adult patients with symptomatic chronic heart failure with reduced injection fraction and is newly reimbursed in Portugal. The generation of real world data regarding sacubitril/valsartan, namely in terms of healthcare resource use and quality of life of these patients, is of major importance for regulatory and health technology assessment purposes.

Cardiovascular risk factors and its association with overweight and obese patients followed in portuguese community pharmacies

Rationale: In order to reduce cardiovascular risk factors, such as obesity, diabetes and dyslipidemia, dietary intervention is heavily needed. This present study aims to: Identify the prevalence of cardiovascular risk factors (CRF) and its association with nutritional status (overweigth/obesity) in Portuguese adults; Evaluate the efficacy of dietary intervention on weight and CRF in this patients.

Dietary intervention for overweight and obese patients followed in portuguese community pharmacies

Dietary intervention for overweight and obese patients followed in portuguese community pharmacies

Community pharmacists' attitudes towards patient leaflets: Exploring perceptions underlying an electronic local production of tailored written information.

IntroductionLow health literacy in Portugal, revealed by limited patients' knowledge of their medication, may be improved by written information that is individually tailored for each patient. Tailored content can be produced through computer software and delivered by community pharmacies to patients.ObjectiveTo assess community pharmacists' real-life management, usage and perceived utility of software developed to produce individually tailored patient leaflets at community pharmacies.MethodsThe software contained five different pharmacist-selected clinical information fields which allows for the adjustment of information to each patient's information needs. Using an exploratory study design, community pharmacists' perceptions were purposively selected and qualitatively assessed. Interviews were recorded, transcribed verbatim and iteratively coded using a thematic approach outlined by attitudinal theory.ResultsEight participants took part in the study. Emerging codes led to the construction of two main themes: Current PLs usage in Portuguese community pharmacy; and Tailored PLs usage in Portuguese community pharmacy. Pharmacists exhibited a generally positive attitude concerning the relevance and use of patient leaflets to address individual patient's information needs, including an improvement in health literacy. The model was considered effective, functional, satisfying and user-friendly.ConclusionAlthough additional studies are needed, the introduction of a leaflet-tailoring software in Portuguese community pharmacies seems to be feasible as an additional resource to improve the quality of patient information and counselling. The next research steps should address the impact on patients' medicines-related information, including the level to which patients are able to correctly interpret the information and to adjust accordingly their health behaviours.Practice implicationsThe software fits present community pharmacy practice and routines, bringing advantages to pharmacists' willingness to deliver meaningful written information to patients, thus contributing to improved patient health literacy.

Identification of inhaler technique errors with a routine procedure in Portuguese community pharmacy.

Background:A correct selection of drugs prescribed, but also the choice of the appropriate inhaler device, is crucial for the control of respiratory diseases.Objective:To evaluate the inhaler technique and identify potential errors of patients when treated with inhalers by testing a routinary procedure to be implemented in any community pharmacy.Methods:Adults with asthma/COPD and under inhalation therapy were invited to demonstrate how they use their inhalers. After direct observation it was registered whether all the sequential steps included in the summary of product characteristics (SmPC) were performed.Results:The study involved 67 patients from 4 community pharmacies (Portugal central region): 34 (50.7%) males, 65.4 (SD=18.28) years old, 42 (62.7%) with COPD, and 23 (34.3%) using more than one inhaler. The 67 patients used 95 inhalers, comprising: 57 (60.0%) multiple dose DPI (dry powder inhalers), 18 (18.9%) single dose DPI, 16 (16.8%) pMDI (pressurized metered dose inhalers), 2 (2.1%) pMDI+spacer and 2 (2.1%) SMI (soft mist inhalers). No errors were made only by 9 (13.4%) patients. In the 75 DPIs techniques, the most frequent errors were ‘no previous forced expiration’ (46=61.3%) and ‘no 10s apnea after inhalation’ (51=68.0%); in the 16 pMDIs techniques common errors were ‘lack of hand-lung coordination’ (7=43.8 %), ‘no previous forced exhalation’ (8=50.0%) and ‘no apnea after inhalation’ (10=62.5%). After inhaling from 56 devices containing corticosteroids, 34 (60.7%) of the patients did not wash their mouth.Conclusion:The study demonstrated the possibility of performing this procedure routinely in Portuguese community pharmacies and also its utility, since 58 (87%) of patients had at least one error during the inhalers use.