pharmaceutical care worldwide - Gastelurrutia

PHARMACEUTICAL CARE WORLDWIDE

Providing Patient Care in Community Pharmacies in Spain Miguel Angel Gastelurrutia, Maria José Faus, and Fernando Fernández-Llimós

OBJECTIVE: To review the current status of Spanish community pharmacy, both in practice and research terms, and analyze its future trends. FINDINGS: Spain has a social security system where all citizens receive health care, social services, and pensions. All medical care and surgery are free for citizens; however, community pharmacies in Spain are privately owned. There are geographic and population standards for the establishment of new pharmacies, resulting in an average of 1 pharmacy per 2000 residents. Almost all pharmacies offer the same services: compounding, weight and blood pressure measurement, and cholesterol and glucose testing. There are also other, less-implemented services, such as methadone supply or directed observed treatments. Most of these services are freely provided, except compounding (fee for service), methadone, and directed observed treatments. University pharmacy practice departments do not exist in Spain, which leads to scarce research in this area. DISCUSSION:

Efforts have been made to describe and measure the prevalence of negative clinical outcomes produced by pharmacotherapy and create an operational procedure to provide pharmacotherapy follow-up.

CONCLUSIONS: Spain has many community pharmacies, but there is little pharmacy practice research. Some advanced cognitive services exist, but few are being remunerated. KEY WORDS:

community pharmacy services, Spain.

Ann Pharmacother 2005;39:2105-10. Published Online, 15 Nov 2005, www.theannals.com, DOI 10.1345/aph.1G121

pain is a European Union member with a population S of 40 million. Its structure is semi-federal, divided into 17 states, which are further divided into 52 provinces. 1

The Spanish Constitution establishes which are the healthcare legislative competences of states and which are reserved to the national government. Each state has legislative powers in relation to community pharmacy or medical services, but they do not have those powers with regard to drug legislation or public health issues. A national consultation body, which was set up in 1986 to coordinate health care,2 has been recently adapted to improve states’ participation in advising the national government.3 Spain has a social security system in which every citizen benefits from the welfare state in terms of health care, social services, and pensions. Health care is organized on the basis of a National Health System that is run by each

Author information provided at the end of the text.

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state. National legislation establishes the following as the characteristics of the system: it is universal, free, and equitable. Public administration covers 71.4% of healthcare expenditures.4 The percentage of healthcare expenditures in relation to the gross domestic product (GDP) was 7.6% in 2002, one of the European Union’s lowest percentages.5 All medical care and surgery are free for citizens. There are 3 levels of copayment for drugs: retired people pay nothing, and those of working age (employed or unemployed) pay 40% of the retail price, except for people with chronic illnesses, who pay 10%. The average percentage of copayment in 2002 was 6.3%, the second lowest in the European Union.6 The National Health System does not cover nonprescription medicines, which represent 8% of total drug sales.7 There are about 20 000 community pharmacies in Spain,8 and this produces an average of 2000 people per pharmacy, one of the lowest ratios in the European Union. All community pharmacies are privately owned, and only

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pharmacists can own a community pharmacy. Moreover, a pharmacist can own only one pharmacy, although more than one pharmacist may jointly own one pharmacy. Pharmacy chain stores are therefore not allowed in Spain. The establishment of new pharmacies is controlled by state governments based on 2 criteria: population per pharmacy and distance from another existing pharmacy. The minimum population allowed for opening a new pharmacy ranges from 700 to 2500 in different states. Therefore, in some states, such as Navarra,9 a pharmacist may establish a new community pharmacy serving only 700 people, while in other states, such as the Basque Country10 (bordering Navarra), 2500 people are necessary to allow the establishment of a new pharmacy. At the same time, the minimum distance between the new pharmacy and an existing one ranges from 150 to 250 meters in different states. To work as a community pharmacist, it is compulsory to register in a Province Pharmacists’ Association, which is a member of the National Pharmacists’ Association. In 2001, there were about 51 000 pharmacists in Spain who were members of the National Pharmacists’ Association, working not only in community pharmacies but also in other settings such as hospitals, health centers, industry, and education.6 According to unpublished data from the National Pharmacists’ Association, in 2003, approximately 13 000 staff pharmacists (non-owners) were working in the 20 000 community pharmacies, with an average of 1.65 pharmacists per pharmacy. Although no census has been taken of technicians, this population is estimated to be about 31 000.11 Some technicians have professional training, but most do not have this education; their functions are limited to administrative jobs. To practice as a pharmacist in a community pharmacy, it is sufficient to hold a 5year university degree in pharmacy, with most people usually 23 years old. Although the Ministry of Health does have an accreditation system for continuous training, it is not compulsory to carry out continuous training to continue practice. In 2003, manufacturers in Spain sold a total of €6346 million in drugs for domestic drug consumption.6 The mark-up by the distributing chain (wholesalers + pharmacies) is done at a ratio of 1:1.59 from manufacturers to customers. Therefore, community pharmacy drug sales are estimated as €10 000 million. About 25% of health expenses are for drugs, and health constitutes about 2% of the Spanish GDP. Further estimates suggest that 85% of pharmacy sales are drugs and 15% are other products, meaning that estimated total sales in Spanish pharmacies are €12 million. Thus, average sales per pharmacy are about €600 000 per year. Community pharmacies are reimbursed by a margin of about 28% of the pharmacy retail price. In 2000, the government passed a law forcing pharmacies to return part of this margin,12 making the actual final margin about 23.7%.13 Owners of pharmacies receive the profits of the global pharmacy business, while staff pharmacists, as happens with technicians, are paid a fixed salary. The staff pharmacists’ salary is usually between €20 000 and €30 000 per year. 2106

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Community Pharmacy Services Law 16/1997 describes community pharmacy services.14 The main service in all pharmacies is the distribution of drugs. This law makes it compulsory to provide patient counseling services, pharmacotherapy follow-up (detecting, preventing, solving negative outcomes of pharmacotherapy), compounding, and pharmacovigilance (adverse drug reaction reporting system) for all Spanish pharmacies, although actual implementation of those services has not been evaluated. In 1997, the National Pharmacists’ Association conducted a survey to analyze non-dispensing services provided in community pharmacies.15 The survey concluded that 90.9% of pharmacies carried out compounding, while other services were height and weight measurement (88.6%), blood pressure measurement (83.5%), pharmacovigilance (37.2%), blood glucose measurement (26.0%), and cholesterol measurement (20.9%). The association has recently performed an update of that survey on the total number of pharmacies, although the level of response (6.9%) indicates that the results should be analyzed with caution. Apart from dispensing, counseling accounted for 56.1%, 35.7% for other health-related services (eg, weight, blood pressure, blood glucose levels), and 8.2% for pharmacotherapy follow-up. This survey revealed that Spaniards visit a pharmacy 14.3 times a year and that 1 of every 3 visitors obtains either advice or a response to a query unrelated to the dispensed drug. According to these data, in 2001, >390 000 blood tests were carried out, mainly glucose and cholesterol levels. Almost all pharmacies continue to measure the blood pressure and weight of adults and infants.11 Other authors have provided similar figures: weight (97%), height (82%), blood pressure measurement (62%), and biochemical blood tests (9.2%). The price of all these services is low and is charged directly to the patient (€1–3), if they are charged at all.16 Prevalence of those services, especially pharmacotherapy follow-up and pharmacovigilance, is not high enough. More research and motivating activities should be implemented to enhance this prevalence. An important advance in defining direct patient services was made in Spain after publishing the Consensus on Pharmacy Services.17 This statement came after an expert panel met under the guidance of the Ministry of Health in 2001. The consequence of this Consensus was the achievement of an agreement on terms related to pharmacists’ services that do not exist in other countries. Consensus defines 3 main services to be provided: dispensing, advising based on symptoms, and pharmacotherapy follow-up. Dispensing means to deliver the drug with certain advice to ensure patient knowledge and consequent adherence with treatment. Advising means helping the patient choose the correct nonprescription drug for his or her minor ailment and, if necessary, refer him or her to the physician. Pharmacotherapy follow-up indicates monitoring a patient’s pharmacotherapy to identify, detect, and prevent negative clinical outcomes. Implementation of these services at high standards may not be as high as expected.


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Providing Patient Care in Spain

Community pharmacies in some states provide other voluntary services, such as the administration of methadone to patients abandoning opiates, and are paid €45 per month per patient, which includes methadone supply and service honoraria. This service is growing and, in some states, 43% of opiate-addicted patients are supplied with methadone at pharmacies.18,19 Although this methadone supply service is part of a public health program, it is not compulsory for all pharmacies to participate; in addition, an accreditation is needed to be included. Other activities focusing on drug addiction include a syringe-exchange program whereby drug users come to the pharmacy with a used syringe and exchange it for a free new one, paid by the state government. In Basque Country in 2003, 23% of injecting drug users’ syringes were provided in this program.20 In other states, community pharmacies provide additional services, such as smoking cessation activities, or directly observed treatment,21 mainly for tuberculosis treatments, which consists of administering pills in the presence of the pharmacist who certifies that the patient is adherent. This last service is being reimbursed in just one state, covering all observed treatments requested by physicians. A new service is being implemented in some community pharmacies and is even being promoted by some province associations. This service is the filling of multicompartmental adherence aid devices.22 This service is not being reimbursed yet, and there is some doubt about its legality because it involves repackaging of original packages into those devices. Another activity on which both a number of associations and specific community pharmacies have focused is detection of “silent” illnesses, such as diabetes or hypertension.23,24 These screening practices allowed identification of high levels of blood glucose in 4% of patients visiting community pharmacies, who were then referred to their physicians.25 Most pharmacies subscribe to a drug-waste collection system (SIGRE) in response to European Directive 94/62 governing container management.26 This service is also free, and its main objective is to recover drug containers and nonused excess for subsequent recycling. Six hundred tons of drug wastes were collected in this plan in 2002, and a further 600 tons were collected over the first quarter of 2003. The margin includes remuneration for all these services, except compounding, which is paid on a fee-for-service basis. A specific law that requires extremely high levels of quality, similar to the International Organization for Standardization standards, has recently regulated compounding.27 Different state governments have announced inspections to assess its implementation. Although a community pharmacy can buy drugs directly from manufacturers, the common practice is to go through a wholesaler. Most drug wholesalers in Spain are cooperatives with pharmacy owners, so they mark up the minimum amount to cover their costs, allowing a bigger margin to pharmacies. The final price of drugs is fixed by the national government based on negotiation with manufacturers when registering the drug. www.theannals.com

Research in Community Pharmacy Spain has 15 faculties of pharmacy and about 24 000 pharmacy students.28 There is still very little pharmacy practice research. One reason for this circumstance is that there are no pharmacy practice departments at universities. Research in this field tends to be performed by groups not linked to a university (associations, wholesalers, private foundations) or by university researchers who work mainly in other fields. With respect to the university, the major group conducting community pharmacy research is the Research Group on Pharmaceutical Care at University of Granada (GIAFUGR), who mainly work with drug-related problems in all settings. They organized the 2 editions of the Granada Consensus on Drug-Related Problems,29,30 which led to defining drug-related problems as negative clinical outcomes resulting from pharmacotherapy31 and created a theoretical framework under the Donabedian Structure, Process and Outcomes paradigm32 and the Economic, Clinical, and Humanistic Outcomes model.33 The GIAF-UGR has also created a systematic tool to identify all negative clinical outcomes in a patient34 and performed a survey to determine the incidence of those negative outcomes as causes of hospital emergency department visits.35 As a result of this study, they concluded that one-third of the visits were caused by a negative clinical outcome associated with pharmacotherapy, of which 70% were preventable conditions. The GIAF-UGR also designed an operational procedure to implement pharmacotherapy follow-up in community pharmacies, the Dader Program,36 and showed that pharmacists’ interventions may solve 76% of negative pharmacotherapy clinical outcomes.37 From January 2000 to May 2004, >500 community pharmacists have provided pharmacotherapy follow-up to >4500 patients, producing >11 000 pharmacist interventions.38 This procedure was also adapted to hospital pharmacies39 and has proven its utility in detecting and resolving negative outcomes in different hospital departments.40-42 Provincial pharmacists’ associations have also led a number of research projects. The Seville Pharmacists’ Association worked alongside respiratory specialists and found that the effectiveness of nicotine replacement treatment in pharmacies was 24.2%, while the effectiveness using bupropion was 34.4%; however, bupropion showed greater numbers of adverse drug reactions.43 The Pontevedra Association demonstrated the non-improvement of antibiotic treatment adherence by dispensing the exact number of pills in pharmacy-filled containers (US way) comparatively to the patient packages prepared by manufacturers (European way).44 Other pharmacists’ groups, not linked to universities, have conducted surveys. The TOMCOR survey showed that, after provision of pharmaceutical care to patients who had suffered an acute coronary episode, those patients would have improved adherence to therapy. Moreover, they would have a better understanding of the reasons for


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their pharmacotherapy.45,46 A survey coordinated by the European Society of Clinical Pharmacy showed that patients recently discharged from the hospital constitute a group prone to pharmacotherapy failure, which could require pharmaceutical care.47 Funding such research activities is difficult since no organized systems exist. The normal procedure is to use a small portion of national or state funds obtained through occasional grants. Pharmacists’ associations make use of members’ fees to finance their research. In spite of these funding restrictions, all of this research, mainly focused on drug-related problems and pharmacotherapy negative outcomes, had a successful impact on the Strategic Plan of Pharmaceutical Policy, recently published by the Ministry of Health.48 This document of legislative intentions includes a chapter devoted to drug-related problems and their importance as a public health issue. Plans for the Next Five Years In 2004, the National Pharmacists’ Association created the Pharmaceutical Care Forum, which contains representatives of a number of pharmacists’ bodies and associations including the Ministry of Health; hospital, community, and primary care associations; and universities. This forum is discussing the possibility of implementing large-scale changes in Spanish pharmacies. A wide range of topics is being discussed, from pharmacy undergraduate education to incentives necessary to implement services. The intention that initiated the creation of this forum was to proactively suggest large-scale changes to the government instead of passively waiting for new regulatory actions. It is too soon to predict the possible success of this forum, which should finish its work in 2006. To measure the dimension of the public health problem constituted by negative outcomes associated with pharmacotherapy is one of the main research activities in Spain. To evaluate the actual incidence of those negative clinical outcomes and their consequences, research is being done by the GIAF-UGR covering a representative sample of patients visiting emergency departments for all Spanish hospitals. Other research by the GIAF-UGR is being designed to evaluate the incidence of those negative clinical outcomes in pharmacy customers. Those 2 projects should present an idea of the magnitude of this problem in Spain. Other initiatives are trying to design facilitators to avoid barriers to the implementation of these services. Remuneration of pharmaceutical services has to be urgently investigated; it is state-driven in Spain, and this leads to a lack of joint planning for the nation as a whole. Any modifications are subject to changes in the remuneration system of community pharmacies. This debate is not currently taking place, although all stakeholders are aware of how important and necessary it is. Perhaps the forum may also shed some light on this topic. As neither states nor the national government are willing to pay for the new services, they are not measuring the implementation or quality of new services being provided. All stakeholders 2108

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are probably aware of the importance of reimbursement discussion, but all of them, including the Ministry, are afraid of initiating it. Graduate and postgraduate education for pharmacists is another topic to address. The Bologna Declaration and some other European Union statements for the new European plan for higher education have prompted reconsideration of pharmacy education. There is discussion whether pharmacy degrees should be 4- or 5-year programs.49 It is expected that creation of new European Masters degrees, probably in pharmacy practice or pharmaceutical care, should produce new practitioners and researchers devoted to these areas. There are some positions that promote compulsory continuing training as a recertification system. Portugal has recently adopted this model, and Spain is observing their results. Spain’s cognitive pharmacy services are not well developed. Research is difficult because of the lack of university pharmacy practice departments. Implementation probably depends more on pioneers’ than on associations’ support. The future lies in the awareness of those associations (regional, national) of the importance of providing cognitive pharmacy services instead of focusing only on distributive services. Miguel Angel Gastelurrutia MSc (Pharm), Community Pharmacist, Pharmaceutical Care Research Group, University of Granada, Granada, Spain Maria José Faus PhD PharmD, Professor of Biochemistry and Molecular Biology; Director of Pharmaceutical Care Research Group, University of Granada Fernando Fernández-Llimós PhD PharmD, Community Pharmacist, Pharmaceutical Care Research Group, University of Granada Reprints: Dr. Faus, Facultad de Farmacia, Campus de la Cartuja, 18071 Granada, Spain, fax 34 986 401 889, [email protected]

References 1. Instituto Nacional de Estadística. Censos de Población y Viviendas 2001. www.ine.es/censo/es/consulta.jsp (accessed 2004 July 14). 2. Ley 14/1986 de 25 de abril, General de Sanidad. BOE 1986;(102 de 29/04/1986):15207-24. 3. Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud. Capítulo X. Consejo Interterritorial. 4. OECD Health Data 2004. Frequently requested data. Table 11: public expenditure on health, % total expenditure on health. www.oecd.org/ dataoecd/13/11/31963489.xls (accessed 2004 Aug 1). 5. OECD Health Data 2004. Frequently requested data. Table 10: total expenditure on health, % GDP. www.oecd.org/dataoecd/13/11/31963489. xls (accessed 2004 Aug 1). 6. Anuario de la comunidad del medicamento 2004. Madrid: Contenidos e informacion de salud, 2004. 7. Esteve A. El medicamento EFP en Europa y España, Se estrecha la brecha? In: Anuario de la comunidad del medicamento 2004. Madrid: Contenidos e informacion de salud, 2004. 8. La Farmacia en España. Consejo general de Colegios Oficiales de Farmacéuticos de España. www.portalfarma.com/home.nsf (accessed 2004 Aug 1). 9. Ley foral 12/2000, de 16 de noviembre, de atención farmacéutica (publicada en el B.O. Navarra número 143 de 27 de noviembre de 2000). 10. Ley 11/1994, de 17 de junio, de ordenación farmacéutica de la comunidad autónoma del país vasco. 11. Consejo General de Colegios Oficiales de Farmacéuticos. Valoración del Consejo Sanitario de las Oficinas de Farmacia. Madrid: Acción Médica, 2003.


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Providing Patient Care in Spain 12. Real Decreto 5/2000, de 23 de junio, de medidas urgentes de contención del gasto farmacéutico público y de racionalización del uso de los medicamentos. Publicado en el BOE de 24 de junio de 2000. 13. Informe sobre Impacto del RD -ley 5/2000 en la oficina de farmacia: Escenario futuro. Madrid: FEFE; 2004. 14. Ley 16/1997 de 25 de abril, de Regulación de Servicios de las Oficinas de Farmacia. 15. Consejo General de Colegios Oficiales de Farmacéuticos. Informe libro Blanco. La aportacion del farmaceutico a la calidad de la asistencia sanitaria en Espana. Madrid: CGCOF, 1997. 16. Acosta J, Alzaga A, Alvarez L, Gudiel M, Fernández-Llimós F. [Structure and services offered by pharmacies at Alcorcon (Madrid) and Bilbao]. Seguimiento Farmacoterapeutico 2003;1:120-3. 17. Dirección General de Farmacia y Productos Sanitarios. Consensus on Pharmaceutical Care. Ars Pharm 2001;42:221-41. 18. Consejo de colegios de farmacéuticos de Euskadi. Los programas con metadona en la comunidad autonoma del Pais Vasco. Valoracion tras tres años de funcionamiento. Bilbao: G&B, 2000. 19. Herrera P, Ortiz E. Estudio de la atencion farmacéutica en las oficinas de farmacia de la comunidad de Madrid incorporadas a los programas de mantenimiento de metadona (abstract C1). Tercer Congreso Nacional de Atención Farmacéutica, November 18–20, 2001, Granada, Spain. 20. Osakidetza-Servicio Vasco de salud. Informe: los programas de prevención de sida en las farmacias, ONG’s y centros penitenciarios de la Comunidad Autonoma del Pais Vasco. Vitoria: Osakidetza, 2003. 21. Conselleria de Sanitat de Valencia, COF Valencia, COF Alicante, COF Castellón, CONFAR, SFAC-CV. Plan de atención farmacéutica de la comunidad valenciana: programa de tratamiento observado directamente en tuberculosis (abstract B10). Tercer Congreso Nacional de Atención Farmacéutica, November 18–20, 2001, Granada, Spain. 22. Atozqui J, Diez A. [Determination of satisfaction with the use of a personalized dosage system]. Pharm Care 2004;6:91-4. 23. Generalitat de Catalunya. Libro Blanco para la integración de las actividades preventivas en las oficinas de farmacia. Barcelona: Generalitat de Catalunya, 1998. 24. Bustos C, Ropinon MC, Moreno A, Rua F. Evaluación de la “campana farmacéutico-sanitaria de detección de posibles hipertensos” (abstract B33). Tercer Congreso Nacional de Atención Farmacéutica, November 18–20, 2001, Granada, Spain. 25. Martinez SR, Fernandez G, Garcia E. Detección de pacientes con valores elevados de glucémica en farmacias comunitarias de Granada (abstract B15). Tercer Congreso Nacional de Atención Farmacéutica, November 18–20, 2001, Granada, Spain. 26. SIGRE, por la salud de la naturaleza. www.sigre.es/principal.htm (accessed 2004 Aug 9). 27. Real Decreto 175/2001 por el que se aprueban las normas de correcta elaboración y control de calidad de fórmulas magistrales y preparados oficinales. BOE 2005;65:9746. 28. Estudio para el diseño del plan de estudios y título de grado en farmacia. Programa de convergencia europea. Madrid: ANECA, 2004:17. www.vc. ehu.es/castellano/paginas/centros/farmacia/anecafarmacia.pdf (accessed 2005 Jan 31). 29. Consensus panel. Granada Consensus on Drug-Related Problems. Pharm Care Esp 1999;1:107-12. 30. Consensus Committee. Second Granada Consensus on Drug Therapy Problems. Ars Pharm 2002;43:175-84. 31. Fernández-Llimós F, Tuneu L, Baena MI, Garcia-Delgado A, Faus MJ. Morbidity and mortality associated with pharmacotherapy. Evolution and current concept of drug-related problems. Curr Pharm Design 2004;10:3947-67. 32. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966;44(suppl):166-206. 33. Kozma CM, Reeder CE, Schulz RM. Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther 1993;15:1121-32. 34. Fernández-Llimós F, Faus MJ, Gastelurrutia MA, Baena MI, Tuneu L, Martinez F. [Systematic identification of negative clinical outcomes from pharmacotherapy]. Seguimiento Farmacoterapéutico 2004;2:195-205. 35. Baena MI, Faus MJ, Marin R, Zarzuelo A, Jimenez J, Martinez Olmos J. [Health related problems as cause of visits to hospital emergency departments]. Med Clin (Barc) 2005;127(7):250-5. 36. Machuca M, Fernández-Llimós F, Faus MJ. Metodo Dáder. Guia de seguimiento farmacoterapéutico. Granada, Spain: Universidad de Granada, 2001.

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37. Martinez F, Fernández-Llimós F, Gastelurrutia MA, Parras M, Faus MJ. [Pilot phase results of the Dáder program for drug therapy followup]. Ars Pharm 2001;42:53-65. 38. Fernández-Llimós F. Programa Dader. 4th Simposium de Resultados del Programa Dader (Simpodader 4). Sevilla, Spain, July 17–18, 2004. 39. Silva-Castro MM, Calleja MA, Machuca M, Faus MJ, FernándezLlimós F. [Pharmacotherapy follow-up to inhospital patients: adapting Dader method] Spanish. Seguimiento Farmacoterapéutico 2003;1:73-81. 40. Bicas Rocha K, Campos Vieira N, Calleja MA, Faus MJ. [Pharmacotherapy failures detection in ambulatory patients and development of tools for pharmacotherapy follow-up] Spanish. Seguimiento Farmacoterapéutico 2003;1:49-57. 41. Campos Vieira N, Bicas Rocha K, Calleja MA, Faus MJ. [Pharmacotherapy follow-up for patients admitted to the Internal Medicine Department of Hospital Infanta Margarita] Spanish. Farm Hosp 2004;28: 251-7. 42. Silva-Castro MM, Calleja Hernandez M, Tuneu L, Fuentes Caparros B, Gutierrez Sainz J, Faus MJ. [Drug therapy follow-up in patients admitted to a surgery department] Spanish. Farm Hosp 2004;28:154-69. 43. Galán Parra MD, Román Alvarado J, Galán Parra I, Juárez Manzano J, Vaquero Prada JP. [Partial results of a collaborative pharmacist–physician program (MEFARTABAC) in Seville community pharmacy]. Prev Tab 2002;4:129-35. 44. Andres JC, Andres NF, Fornos JA. [Assessing pharmacist interventions on antibiotic therapy adherence] Spanish. Seguimiento Farmacoterapéutico 2004;2:97-102. 45. Alvarez de Toledo F, Arcos P, Eyaralar T, Abal F, Dago A, Cabiedes L, et al. [Pharmaceutical care in people who have had acute coronary episodes (TOMCOR study)]. Rev Esp Salud Pública 2001;75: 375-87. 46. Alvarez de Toledo F, Arcos P, Cabiedes L, Dago A, Eyaralar MT. [Costs and effectiveness of pharmaceutical care in community pharmacies]. Farmacoeconomia 1995;2:9-20. 47. Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci 2004;26:353-60. 48. Plan Estrategico de Politica Farmacéutica para el Sistema Nacional de Salud Español. Madrid: Ministerio de Sanidad y Consumo, 2004. 49. European Commission. EUROPA. Education and Training, the Bologna process: next stop Bergen 2005. http://europa.eu.int/comm/education/ policies/educ/bologna/bologna_en.html (accessed 2005 Jan 31).

EXTRACTO OBJETIVO: Revisar el estado actual de la farmacia comunitaria, tanto en términos de práctica como de investigación, y analizar sus tendencias futuras. HALLAZGOS: España tiene un sistema de seguridad social en el que todos los ciudadanos reciben asistencia sanitaria. Toda la atención médica y la cirugía son gratuitas para los ciudadanos. Sin embargo, las farmacias comunitarias son privadas. Existen normas geográficas y de población para el establecimiento de nuevas farmacias, resultando una media de una farmacia por cada 2000 residentes. Casi todas las farmacias ofrecen los mismos servicios: formulación magistral, medida de peso y presión arterial, y análisis de glucosa y colesterol. Existen otros servicios menos implantados, como la provisión de metadona o los tratamientos directamente observados. La mayoría de estos servicios son proporcionados gratuitamente, excepto la formulación (pago por servicio), la metadona, y los tratamientos directamente observados. En España, no existen departamentos universitarios de práctica farmacéutica, lo que produce una escasez de investigación en esta área. DISCUSIÓN: Se han realizado esfuerzos para describir y medir la prevalencia de resultados clínicos negativos producidos por la farmacoterapia y para crear un procedimiento operativo para proporcionar seguimiento farmacoterapéutico. CONCLUSIONES: España tiene muchas farmacias comunitarias, pero hay poca investigación en práctica farmacéutica. Existen algunos servicios cognitivos avanzados, pero pocos están siendo remunerados.


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Décrire l’état actuel de la pharmacie communautaire en Espagne du point de vue pratique et recherche ainsi qu’analyser ses tendances futures. RÉSULTATS: L’Espagne possède un système de sécurité sociale où tous les citoyens reçoivent des soins de santé, des services sociaux, et une pension. Les soins médicaux et chirurgicaux sont sans frais au citoyen. Cependant, les pharmacies communautaires en Espagne sont des entreprises privées. Il existe des standards géographiques et de population pour l’établissement de nouvelles pharmacies, résultant en une moyenne d’une pharmacie par 2000 habitants. Presque toutes les pharmacies offrent les services de préparations magistrales, de prise de poids et de tension artérielle, de prise de glycémie et du taux de cholestérol. Il existe d’autres services offerts moins fréquemment, tels des cliniques de méthadone ou des cliniques d’observation de traitement. La plupart de ces services sont gratuits excepté pour les OBJECTIF:

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préparations magistrales, la méthadone, et l’observation directe de traitement. La présence de département de pratique pharmaceutique universitaire est inexistante en Espagne et est responsable de l’absence de recherche en ce domaine. DISCUSSION: Des efforts ont été déployés pour décrire et mesurer la prévalence de résultats cliniques adverses causés par la pharmacothérapie et pour créer une procédure opérationnelle en vue de prodiguer un suivi pharmacothérapeutique. CONCLUSIONS: L’Espagne est dotée de pharmacies communautaires privées. Malheureusement, peu de recherche s’effectue auprès de ce groupe. Des services cognitifs avancés sont dispensés à la population mais trop peu sont rémunérés.


Marc M Perreault

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