ORCID Profile
0000-0002-6491-1984
Current Organisation
University of Technology Sydney
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Publisher: Research Square Platform LLC
Date: 23-10-2020
DOI: 10.21203/RS.3.RS-93288/V1
Abstract: Background Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). Methods The cRCT was conducted for six months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-effectiveness ratio (ICER) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the ten days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences.Results A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n=523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p=0.053). When considering only MAS patients presenting with symptoms, the ICER was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness.Conclusions Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP.Trial registrationThe study was not registered but it was approved by the University of Granada Ethics Committee (approval number 331/CEIH/2017) and Xátiva-Ontinyent Ethics Committee “Lluís Alcanyís”.
Publisher: Public Library of Science (PLoS)
Date: 17-10-2023
Publisher: Editorial de la Universidad de Granada
Date: 13-03-2019
Abstract: Objetivo: Elaborar una guía práctica de seguimiento farmacoterapéutico (SFT) en el paciente con epilepsia tras el análisis de la información disponible, dirigida a todos los profesionales sanitarios involucrados en la atención del paciente, centrada en el farmacéutico comunitario. Método: Se llevó a cabo una revisión bibliográfica con fecha límite del 15 de junio de 2017. La estrategia de búsqueda consistió en una revisión de fuentes prefiltradas de evidencia en epilepsia, guías de Atención Farmacéutica y Seguimiento Farmacoterapéutico, libros de farmacología humana y dispensación de medicamentos, bases de datos de evidencia científica y bases de datos del medicamento. Resultados: Durante la realización del SFT en el paciente con epilepsia, se debe evaluar el tratamiento mediante la presencia de indicadores de necesidad (existencia del problema de salud que justifica su uso), efectividad (ausencia o disminución del número de crisis epilépticas) y seguridad (ausencia de efectos adversos, contraindicaciones e interacciones). Todo ello para diseñar una estrategia de intervención con el paciente y/o el resto de los profesionales sanitarios involucrados con el fin de mejorar la calidad de vida del paciente. Conclusiones: Esta guía pretende ser un recurso útil para el farmacéutico comunitario en la realización del SFT en el paciente con epilepsia, puesto que contiene toda la información necesaria acerca de la enfermedad y los tratamientos empleados. Siempre considerando al paciente como una unidad, no fraccionado en función de sus problemas de salud.
Publisher: FapUNIFESP (SciELO)
Date: 2022
Publisher: Frontiers Media SA
Date: 11-07-2023
DOI: 10.3389/FPHAR.2023.1105434
Abstract: Background: Data analysis techniques such as machine learning have been used for assisting in triage and the diagnosis of health problems. Nevertheless, it has not been used yet to assist community pharmacists with services such as the Minor Ailment Services These services have been implemented to reduce the burden of primary care consultations in general medical practitioners (GPs) and to allow a better utilization of community pharmacists’ skills. However, there is a need to refer high-risk patients to GPs. Aim: To develop a predictive model for high-risk patients that need referral assisting community pharmacists’ triage through a minor ailment service. Method: An ongoing pragmatic type 3 effectiveness-implementation hybrid study was undertaken at a national level in Spanish community pharmacies since October 2020. Pharmacists recruited patients presenting with minor ailments and followed them 10 days after the consultation. The main outcome measured was appropriate medical referral (in accordance with previously co-designed protocols). Nine machine learning models were tested (three statistical, three black box and three tree models) to assist pharmacists in the detection of high-risk in iduals in need of referral. Results: Over 14′000 patients were included in the study. Most patients were female (68.1%). With no previous treatment for the specific minor ailment (68.0%) presented. A percentage of patients had referral criteria (13.8%) however, not all of these patients were referred by the pharmacist to the GP (8.5%). The pharmacists were using their clinical expertise not to refer these patients. The primary prediction model was the radial support vector machine (RSVM) with an accuracy of 0.934 (CI95 = [0.926,0.942]), Cohen’s kappa of 0.630, recall equal to 0.975 and an area under the curve of 0.897. Twenty variables (out of 61 evaluated) were included in the model. radial support vector machine could predict 95.2% of the true negatives and 74.8% of the true positives. When evaluating the performance for the 25 patient’s profiles most frequent in the study, the model was considered appropriate for 56% of them. Conclusion: A RSVM model was obtained to assist in the differentiation of patients that can be managed in community pharmacy from those who are at risk and should be evaluated by GPs. This tool potentially increases patients’ safety by increasing pharmacists’ ability to differentiate minor ailments from other medical conditions.
Publisher: Edittec
Date: 30-09-2018
Publisher: EManuscript Technologies
Date: 22-12-2020
Publisher: Edittec
Date: 30-12-2019
Publisher: Public Library of Science (PLoS)
Date: 25-10-2022
DOI: 10.1371/JOURNAL.PONE.0275252
Abstract: Self-perceived minor ailments might conceal other health conditions if patients are not appropriately assisted by health care professionals. The aim of the study was to evaluate the patient-related outcomes of a community pharmacy Minor Ailment Service (MAS) compared to usual pharmacist care (UC). A cluster randomised controlled trial was conducted over six months in community pharmacy in the province of Valencia (Spain). Patients seeking care or requesting a product for a minor ailments considered in the study (dermatological problems, gastrointestinal disturbance, pain and upper respiratory tract related symptoms) were included. The intervention consisted of a standardised pharmacist-patient consultation guided by a web-based program using co-developed management protocols and patients’ educational material. Patients were followed up by phone ten days later. Primary clinical outcomes were appropriate medical referral and modification of direct product request. Secondary outcomes were symptom resolution and reconsultation rates. A total of 808 patients (323 MAS and 485 UC) were recruited in 27 pharmacies of 21 municipalities. Patients visiting MAS pharmacies had higher odds for being referred to a physician (OR = 2.343, CI95% = [1.146–4.792]) and higher reconsultation rates (OR = 1.833, CI95% = [1.151–2.919]) compared to UC. No significant differences between groups were observed for modification of direct product request and symptom resolution. The use of management protocols through the MAS strengthened the identification of referral criteria such as red flags in patients suffering minor ailments. These patients with symptoms of minor ailments possibly due to more severe illness were to be referred and evaluated by physicians. Results reinforce that MAS increases safety for those patients consulting in community pharmacy for minor ailments. Trial registration number: ISRCTN17235323 . Retrospectively registered 07/05/2021, www.isrctn.com/ISRCTN17235323 .
Publisher: Edittec
Date: 24-05-2023
Publisher: Elsevier BV
Date: 11-2020
Publisher: Edittec
Date: 20-01-2021
Publisher: Elsevier BV
Date: 12-2023
Publisher: Elsevier BV
Date: 11-2023
Publisher: Editorial de la Universidad de Granada
Date: 22-06-2022
Abstract: Introducción: la Evaluación Clínica Objetiva Estructurada (ECOE) es una de las herramientas más novedosas y con mejores resultados en la evaluación de competencias clínicas. Su uso en Farmacia constituye una oportunidad para innovar y mejorar el proceso de enseñanza-aprendizaje. Método: el proceso de implementación se estructuró en dos etapas: 1) Fase de preparación, que incluyó el diseño teórico de la prueba ECOE con tres componentes clave (Comité Organizador, Mapa de Competencias y Tabla de Especificaciones y Selección de Casos y Diseño de Estaciones) y la planificación práctica con el montaje de la prueba 2) Fase de ejecución y evaluación de resultados. Resultados: el estudio piloto se desarrolló en la Facultad de Farmacia de la Universidad de Granada, España en el curso 2018-2019, y participaron 33 estudiantes de AF de Grado y 14 estudiantes de Máster en AF. Se evaluaron cinco competencias: Clínica, Técnica, Servicios Farmacéuticos Asistenciales, Comunicación y Actividades Educativas, distribuidas en cinco estaciones, tres de paciente simulado estandarizado y dos estaciones escritas. Se identificaron los recursos materiales, humanos y económicos necesarios, se elaboraron los documentos de cada estación y se seleccionaron y entrenaron los participantes. Conclusiones: la prueba ECOE es una herramienta útil e idónea para evaluar las competencias específicas de Atención Farmacéutica. El procedimiento descrito y los elementos clave identificados facilitan la implantación de este tipo de pruebas innovadoras en Farmacia.
Publisher: EManuscript Technologies
Date: 17-05-2021
Publisher: Elsevier BV
Date: 03-2023
Publisher: Springer Science and Business Media LLC
Date: 20-11-2021
DOI: 10.1186/S12913-021-07188-4
Abstract: Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’ training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time, medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% ( n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs ( p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.SEMERG.2019.10.003
Abstract: To quantify the proportion of oral antibiotics through private prescription (PP) and irregular prescription (IP) in the Community Pharmacy (CP). Cross-sectional multicentre study carried out in Spanish community pharmacies over a 4week period, one in each season of the year. An analysis was made of private and irregular prescriptions of oral J01 antibacterials for systemic use (Anatomical Therapeutic Chemical [ATC] classification). The study variables used were prescription and consultation characteristics. A total of 3569 PP (71% followed legislation) and 833 IP were recorded by 365 pharmacists working in 247 CP. PP were prescribed by dentists (43.7%), general practitioners (GP) (26.20%), and paediatricians (10.3%), to treat teeth infections (39.8%), upper respiratory infections (25.6%), lower respiratory infections (10.3%), and urinary infections (7.7%). The most prescribed antibiotics were amoxicillin (27.9%) and amoxicillin-clavulanic (25.2%). IP came from Emergency Departments (32.8%), oral hone prescriptions (20.4%), and patient demand due to insufficient quantity of antibiotic to complete treatment (10%). Prescriptions came from GP (25.2%), dentists (24.7%), and paediatricians (12%) to treat upper respiratory infections (32.5%), teeth infections (25.8%), urinary infections (14.2%), and lower respiratory infections (10.8%). The most prescribed antibiotics were amoxicillin-clavulanic (27.4%) and amoxicillin (21.6%). Since every patient with IP was referred to the GP, 45.4% of them accepted the recommendations of the pharmacists. This study obtained PP and IP characteristics, unknown and needed data in Spain for future health policy plans.
Location: Switzerland
Location: Spain
Location: United Kingdom of Great Britain and Northern Ireland
Location: Switzerland
No related grants have been discovered for Noelia Amador-Fernández.