Ongoing projects on pharmaceutical care services in Spain, September 2016

Julio Andres Jacome, PharmD

In Spain, there are several institutions developing projects on pharmaceutical care services, both of research or implementation. Some of the major ongoing projects are described and referenced below.

GENERAL PHARMACEUTICAL COUNCIL OF SPAIN

(www.portalfarma.com)

This institution heads the “Strategic plan for the development of pharmaceutical care” since 2004, consisting of annual actions that have dealt with different issues every year: gastrointestinal problems, hypertension, musculoskeletal pain, mood disorders, diabetes, chronic venous insufficiency, osteoporosis, statins, smoking cessation, common cold and proton pump inhibitors.

The results of the last finished action (ASPIRA 2015) were shown in the last FIP Congress (Buenos Aires, august 2016). The “Study of the effect of community pharmacists on the knowledge of the inhalation technique in asthmatic patients using a new inhaler” included 489 patients recruited at 149 community pharmacies and monitored during 3 months. The results showed improvements in knowledge, adherence and quality of life.¹

The current action, about pharmacovigilance in new oral antidiabetic drugs, is in progress (VIGILA 2016), and the next one will focus on patients with Alzheimer disease (ENMENTE 2017).

Furthermore, the General Pharmaceutical Council of Spain leads the CONSIGUE Project, along with the Pharmaceutical care research group of the University of Granada and other institutions.

The phase 1 of the project (CONSIGUE Impact) assessed the impact of a medication review with follow-up service on clinical, humanistic and economic outcomes of aged polypharmacy patients. In this cluster randomized controlled trial, 1,403 patients were followed over 6 months in 178 community pharmacies. The service achieved significant decreases in poorly controlled health problems, emergency department visits and hospitalizations; and improved significantly the quality of life. Additionally, different pharmacoeconomic analyses have been recently published, suggesting that the service is highly cost effective.^2,3

The phase 2 of the project (CONSIGUE Implementation) is currently in progress, intending to facilitate the sustainable implementation of the service.

Finally, the General Pharmaceutical Council of Spain, in collaboration with other pharmacy institutions, is starting the CONCILIA Project, aimed at the development of a coordinated service of medication reconciliation between the different levels of health care. The first phase of the project has started in 4 cities (Aviles, Vigo, Salamanca and Granada), with the participation of 50 pharmacies and 4 public hospitals. This program will allow the validation of the procedures, definitions and communication tools. In a further stage, the economic, humanistic and clinical impact of the service will be measured.

SPANISH SOCIETY OF FAMILY AND COMMUNITY PHARMACY

(www.sefac.org)

This scientific society develops numerous projects in different areas, both of pharmaceutical care or public health services. Some parts of the current studies about pharmaceutical care services were shown in the last PCNE symposium held in Hillerod, Denmark, in February 2016, including IVALOR (“Protocol for consensus-based pharmaceutical indication between the Spanish society of family and community pharmacy and medical scientific societies”), CONECTA (“Family doctor / community pharmacist communication programme”), CESAR (“Qualification for providing smoking cessation services in community pharmacies”), and IMPACHTA (“SEFAC and SEHLELHA training in hypertension and vascular risk, and SEFAC certification of community pharmacists for the provision of hypertension and vascular risk services”).⁴ Moreover, SEFAC is currently developing another two big qualification programs: EPOCA (COPD prevention and control in community pharmacy) and REVISA (Medication use review service).

PHARMACEUTICAL CARE SPAIN FOUNDATION

(www.pharmaceutical-care.org)

This Foundation is the pioneer institution aimed at promoting the development of pharmaceutical care in Spain. It involves individual pharmacists and pharmaceutical institutions of all levels of health care, supports projects of other institutions and heads its own projects, like MEDAFAR and AFPRES.

The MEDAFAR Project intends to improve the communication between primary care doctors and community pharmacists through the electronic prescription system. It is a project with 5 phases. In phase 1 a consensus was established with the criteria for pharmaco-therapeutical referrals to doctor in asthma and hypertension. It was published in phase 2, and tested in a number of pharmacies and their related health centres in phase 3. In phase 4, the clinical situations subject to referral due to pharmacotherapy problems were classified. At present, the phase 5 is in progress, designed to test the functionality of the communication through the electronic prescription system.⁵

The AFPRES Project is divided into 2 phases. The first phase (AFPRES CLM) was organized along with the Pharmaceutical Council of Castilla-La Mancha and the Pharmaceutical care research group of the University of Granada. It was a cluster randomized controlled trial with 319 hypertensive medicated patients from 63 pharmacies, followed during 6 months. It was developed to assess the impact of a community pharmaceutical care program on health outcomes. The preliminary findings of the study were shown in the last PCNE Symposium: “Effectiveness of pharmaceutical care in medicated hypertensive patients. AFPRES CLM Study”.⁴ The main results were: A significantly higher proportion of patients with controlled blood pressure in the intervention group at the end of the study, and a significant reduction in primary and urgent care visits. No significant changes were found in quality of life, specialist visits or hospitalizations. A second phase (AFPRES NATIONAL) is being prepared, including pharmacoeconomic analyses to assess the efficiency of the service.

References

¹Aguilar J, Amaro L, Lopez-Torres R, Recio C, Martin L, Megia C et al. Study of the effect of community pharmacists on the knowledge of the inhalation technique in asthmatic patients using a new inhaler. ASPIRA. FIP Congress; 2016; Buenos Aires, Argentina.

²Jodar-Sanchez F, Malet-Larrea A, Martin JJ, Garcia-Mochon L, Lopez Del Amo MP, Martinez-Martinez F et al. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: The CONSIGUE Program. Pharmacoeconomics. 2015;33(6):599-610.

³Malet-Larrea A, Goyenechea E, Garcia-Cardenas V, Calvo B, Arteche JM, Aranegui P et al. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br J Clin Pharmacol. 2016;82(3):831-8.

⁴Abstracts working symposium 2016 Pharmaceutical Care Network Europe, 19-20 february 2016, Hillerod, Denmark. Int J Clin Pharm. 2016;38(4):1005-22.

⁵Pastor-Sanchez R, Sola N, Alvarez de Toledo F, Casado P, Ricote M, Dago A. Validation of the classification of pharmaco-therapeutical referrals. MEDAFAR IV Study. FIP Congress; 2016; Buenos Aires, Argentina.