Diabetes policies and pharmacy-based diabetes interventions in Portugal: a comprehensive review.
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ABSTRACT: Background
Pharmacy-based interventions are complex public health endeavors which include, but are not restricted to, the conventional medication supply role. In diabetes, such interventions may improve patients' outcomes. The aim of this study was to review relevant policies and research developed in Portugal directed at pharmacy-based diabetes interventions, and to inform future policies, practice and research in collaborative practice with primary care.Research method
An exploratory review of diabetes legislation and policy papers, as well as a comprehensive review in Embase, MEDLINE (via Ovid and PubMed), Google Scholar, and grey literature until November 2017 was performed.Results
Sixteen policy papers and 10 studies were included in the analysis. Positive evidence from pharmacy interventions was retrieved concerning screening individuals at risk, screening uncontrolled patients, managing diabetes, and supporting self-monitoring.Conclusions
Some consistency in favorable findings, but also room for improvements in health policies, intervention design and research methods, were observed.
SUBMITTER: Costa S
PROVIDER: S-EPMC6427867 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Publications
Diabetes policies and pharmacy-based diabetes interventions in Portugal: a comprehensive review.
Costa Suzete S Horta Maria Rute MR Santos Rita R Mendes Zilda Z Jacinto Isabel I Guerreiro José J Cary Maria M Miranda Ana A Helling Dennis K DK Martins Ana Paula AP
Journal of pharmaceutical policy and practice 20190321
<h4>Background</h4>Pharmacy-based interventions are complex public health endeavors which include, but are not restricted to, the conventional medication supply role. In diabetes, such interventions may improve patients' outcomes. The aim of this study was to review relevant policies and research developed in Portugal directed at pharmacy-based diabetes interventions, and to inform future policies, practice and research in collaborative practice with primary care.<h4>Research method</h4>An explo ...[more]
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Project description:BackgroundAlthough prescription opioid dispensing rates have continued to decrease, overdose deaths involving prescription opioids have increased during the COVID-19 pandemic. Screening and brief interventions (SBI) are an effective prevention strategy to identify and address opioid misuse and safety risks. Emerging literature on pharmacy-based SBI needs to be systematically appraised to develop robust interventions.ObjectiveOur objective was to conduct a scoping review of the literature regarding pharmacy-based opioid misuse SBI to identify relevant literature that explore the topic, evaluate the patient-centeredness of included studies, and explore the use of dissemination and implementation science in the literature.MethodsThe review was conducted according to Preferred Reporting of Systematic Reviews and Meta-analyses -Scoping reviews (PRISMA-Sc) guidelines. We searched PubMed, CINHAL, PsychInfo, and Scopus for studies regarding pharmacy-based SBI, published in the last 20 years. We also conducted a separate grey literature search. Two of three total reviewers screened each abstract individually and identified eligible full-texts for inclusion. We critically appraised quality of included studies and qualitatively synthesized the relevant information.ResultsThe search resulted in 21 studies (categorized as intervention, descriptive, and observational research) and 3 grey literature reports. Of the recently published 21 studies, 11 were observational research, with six interventions in the pilot stages. Screening tools varied but naloxone was the brief intervention in 15 of the 24 results. Only eight studies had high validity, reliability, and applicability and only five were patient-centered. Implementation science principles were addressed in eight studies (mainly interventions). Overall, the findings suggest high potential for evidence-based SBI to be successful.ConclusionsOverall, the review suggested a strong lack of a patient-centered and implementation science-focused approach to designing pharmacy-based opioid misuse SBI. Findings suggest that a patient-centered, implementation focused approach is needed for effective and sustained pharmacy-based opioid misuse SBI.
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Project description:ImportancePharmacy deserts have increased, potentially affecting patient access and care. Historically, telepharmacies have been used to reduce pharmacy deserts to restore access, but states frequently restrict their operation.ObjectiveTo analyze whether telepharmacy policy is associated with pharmacy deserts and access to pharmacy services.Design, setting, and participantsThis cohort study analyzed pharmacy location and census data from 2016 through 2019 for US states with new telepharmacy policies. Nearby control states were used for comparison in a pretest-posttest nonequivalent group design. Statistical analysis was performed from January 2022 to July 2023.ExposureIntervention states were selected if a change in telepharmacy policy was adopted in 2017 or 2018.Main outcomes and measuresPharmacy deserts were defined as any geographic area located at least 10 miles from the nearest pharmacy. Primary outcomes included the change in number of telepharmacies, pharmacy deserts, and population in pharmacy deserts. Secondary outcomes included the percentage of telepharmacies located in medically underserved areas or populations (MUA/Ps), and the association between a telepharmacy opening nearby and the transition of a pharmacy desert into a nonpharmacy desert.ResultsTwelve US states were included in the study (8 intervention states, 4 control states). Intervention states experienced an increase in the mean number of telepharmacies to 7.25 with a range of 4 (Arizona, Indiana) to 14 (Iowa), but control states remained at a mean of 0.25 telepharmacies with a range of 0 to 1 (Kansas). Compared with controls, intervention states experienced a 4.5% (95% CI, 1.6% to 7.4%) decrease in the percentage of places defined as pharmacy deserts (P = .001) and an 11.1% (95% CI, 2.4% to 22.6%) decrease in the population in a pharmacy desert (P = .03). Telepharmacies were more likely to be located in a MUA/P than traditional pharmacies (preperiod in MUA/P: 63.2% of telepharmacies [12 of 19] vs 33.9% of traditional pharmacies [5984 of 17 511]; P = .01; postperiod in MUA/P: 62.7% of telepharmacies [37 of 59] vs 33.7% of traditional pharmacies [5998 of 17 800]; P < .001). When a telepharmacy was established in pharmacy deserts, 37.5% (30 of 80) no longer met the study's definition of a pharmacy desert the following year. In contrast, only 1.8% of places (68 of 3892) where a nearby telepharmacy did not open experienced this change (χ21=416.4; P < .001).Conclusions and relevanceIn this cohort study, intervention states experienced a reduced population in pharmacy deserts, suggesting an association with new telepharmacy openings. States aiming to improve pharmacy access might consider less restrictive telepharmacy policies to potentially elicit greater patient outcomes.
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Project description:BackgroundCommunity pharmacists can deliver health care advice at an opportunistic level, related to prescription or non-prescription medicines and as part of focused services designed to reduce specific risks to health. Obesity, smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK, and interventions led by community pharmacists, aimed at these three risk factors, have been identified by the government as public health priorities. In 2008, the Department of Health for England stated that 'a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed'; this systematic review aims to respond to this requirement.Methods/designWe will search the databases MEDLINE, Embase, CINAHL, PsycINFO, Social Sciences Citation Index, ASSIA, IBSS, Sociological Abstracts, Scopus and NHS Economic Evaluation Database for studies that have evaluated interventions based on community pharmacies that aim to target weight management, smoking cessation and alcohol misuse. We will include all randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) and repeated measures studies. Data from included studies will be extracted by two independent reviewers and will include study details methods, results, intervention implementation/costs and methodological quality. Meta-analysis will be conducted if appropriate; if not, the synthesis will be restricted to a narrative overview of individual studies looking at the same question.DiscussionThe review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management, smoking cessation and alcohol misuse. It will also explore if, and how, socio-economic status, gender, ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised, implemented and delivered, since context is an important factor governing the success of public health interventions. The findings from this review will have an impact on the commissioning of public health services aiming to promote healthy weight, smoking cessation and prevent excessive alcohol consumption.Systematic review registrationThe review has been registered with PROSPERO (registration no. CRD42013005943). Available at: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42013005943.
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Project description:Background The coronavirus disease 2019 pandemic has prompted the exploration of new response strategies for such health contingencies in the near future. Over the last 15 years, several pharmacy-based immunization (PBI) strategies have emerged seeking to exploit the potential of pharmacies as immunization, medication sale, and rapid test centers. However, the participation of pharmacies during the last pandemic was very uneven from one country to another, suggesting a lack of consensus on the definition of their roles and gaps between the literature and practice. Purpose This study aimed to consolidate the current state of the literature on PBI, document its progress over time, and identify the gaps not yet addressed. Moreover, this study seeks to (i) provide new researchers with an overview of the studies on PBI and (ii) to inform both public health and private organization managers on the range of possible immunization models and strategies. Methodology A systematic review of scientific qualitative and quantitative studies on the most important scientific databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyzes guidelines were followed. Finally, this study discusses the trends, challenges, and limitations on the existing literature on PBI. Findings Must studies concluded that PBI is a beneficial strategy for the population, particularly in terms of accessibility and territorial equity. However, the effectiveness of PBI is affected by the economic, political, and/or social context of the region. The collaboration between the public (government and health departments) and private (various pharmacy chains) sectors contributes to PBI's success. Originality Unlike previous literature reviews on PBI that compiled qualitative and statistical studies, this study reviewed studies proposing mathematical optimization methods to approach PBI.
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Project description:IntroductionCommunity-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review.MethodsWith a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process.ResultsOf the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries.ConclusionsImplementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.
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Project description:AimAlthough mindfulness-based interventions (MBIs) are routinely used in clinical practice, a comprehensive synthesis of the effectiveness of MBIs for non-affective psychosis has yet to be conducted. The aim of the present review and meta-analysis was to investigate the effectiveness of MBIs including those with mindfulness as an active treatment component for alleviating symptoms of psychosis to inform future clinical practice.MethodsA systematic review of studies published in journals or in dissertations in CINAHL, PubMed, EMBASE, PsycINFO, CENTRAL, ISRCTN, or CNKI from January 1990 until December 2020. A total of 31 eligible studies (n = 2146) were included.ResultsEffect-size estimates suggested that 22 independent samples (n = 1632) produced a statistically significant small effect for psychotic symptoms (g = -0.48), and with a clinically significant reduction of 50% from baseline (pooled OR: 1.84). Separate meta-analyses demonstrated small effects for affective symptoms (g = -0.44) and small-to-large positive effects for quality of life (g = 0.38), mindfulness skills (g = 0.45), and insight into illness/treatment (g = 1.35). The heterogeneity was high across the studies.ConclusionResults suggest that short-term MBIs can be beneficial for non-affective psychosis. Future research is needed to test the efficacy and safety of dedicated MBIs for this population group over a longer term. KEY MESSAGESSchizophrenia spectrum and other psychotic disorders, also known as non-affective psychosis, is the most chronic and debilitating type of psychosis, seriously affecting every aspect of a person's life, including social, occupational, or general functioning.The aim of the current systematic review and meta-analysis was to investigate formerly unexamined questions regarding the clinical significance of MBIs including yoga as an increasingly utilized, conceptualized psychological intervention on overall psychotic symptoms for people with non-affective psychosis.No serious adverse events were reported in the studies, suggesting that MBIs may be safe interventions, while there is robust evidence to support the view that MBIs are beneficial to young people in particular.
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Project description:BackgroundAlthough the World Health Organisation (WHO) has proposed the use of fiscal policies to mitigate consumption externalities such as overweight and obesity-related diseases, very little is known about the impacts of the different types and framing of national and/or regional fiscal policies that have been implemented over the years. There is the need to provide up-to-date evidence on the impact of fiscal policies that have been enacted and implemented across the globe.MethodsWe conducted a scoping review of all implemented government fiscal policies in the food and drinks sector to identify the different types of fiscal policies that exist and the scope of their impact on consumers as well as the food environment. Electronic databases such as the Web of Science and Google Scholar were used to search for appropriate literature on the topic. A total of 4,191 articles were retrieved and 127 were synthesized and charted for emerging themes.ResultsThe results from this review were synthesized in MS Excel following Arksey & O'Malley (2005). Emerging themes were identified across different countries/settings for synthesis. The results confirms that fiscal policies improve consumers' health; increase the prices of foods that are high in fats, sugar, and salt; increase government revenue; and shift consumption and purchases towards healthier and untaxed foods.ConclusionGovernments already have the optimum tool required to effect changes in consumer behaviour and the food environment.
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Project description:Impact of dietary interventions on pre-diabetic oral and gut microbiome, metabolites and cytokines
| PRJEB64861 | ENA