Pharmaceutical Care provision from the pharmacist’s perspective: a qualitative study in Belgian and Cuban contexts.
Main Article Content
Keywords
Qualitative Research, Pharmaceutical Care, implementation
Abstract
Background: Over the past decades, the qualitative research approach has played a crucial role in supporting the adoption of Pharmaceutical Care (PhC) and offers a valuable approach to explore health issues from a social and cultural perspective. It delves into attitudes, perceptions, behaviours, beliefs, and social representations related to health phenomena.
Objective: To explore the experiences, insights and outlook of pharmacists regarding the development of PhC in daily practice in Belgium and Cuba.
Methods: A qualitative study was conducted using a semi-structured interview guide. Thematic content analysis was used. Themes emerged by examining key phrases in the interviewees' responses.
Results: Fifteen interviews with 18 professionals in Belgium and 10 interviews from Cuba were conducted. In total, 18 themes emerged from the Belgian and Cubans interviewees, 12 common themes and six non-overlapping themes. Common issues addressed in both countries include: access to patient records, lack of time, pharmacy staff and private spaces, legal framework, and non-systematic practice of PhC, pharmacists' attitudes, interaction with physicians, the need for collaborative practice, insufficient recording of PhC activity, and continuity of care between levels of care. Themes specific to Belgium include the need for remuneration, patient loyalty to a single pharmacy, and quality control of PhC services. Meanwhile, Cuba faces particular challenges such as a lack of materials and technological resources, shortages of medicines, and inadequate administrative support.
Conclusion: Both Belgium and Cuba face challenges in implementing pharmaceutical care (PhC). Despite their differences, both countries need to enhance PhC by improving resources, tools, and monitoring. Belgium has made progress in PhC, while Cuba faces resource limitations. The holistic approach to pharmacists' professional perception and practice is still limited.
References
1. World Health Organization. Medication Without Harm. [Internet]. 2017. https://www.who.int/publications/i/item/WHO-HISSDS-2017.6
2. Almarsdóttir AB, Granas AG, Blondal AB. Chapter 3 - Clinical and Social Perspectives on Pharmacy Services. In: Thomas D,
editor. Clinical Pharmacy Education, Practice and Research. Elsevier; 2019;31-40. https://www.sciencedirect.com/science/article/pii/B9780128142769000039
3. Lugo GB, Concepción Z, Aguilar-Rabito A, Samaniego LR, Maidana de Larroza GM. Barriers that prevent effective implementation of Pharmaceutical Care. Ars Pharm. 2019;60(4):199-204. Spain.
4. Van Mil JWF, De Boer W0, Tromp THFJ. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract.2001;9:163-8.
5. Okonta JM, Okonta EO, Ofoegbu TC. Barriers to Implementation of Pharmaceutical Care by Pharmacists in Nsukka and Enugu metropolis of Enugu State. J Basic Clin Pharm. 2012;3(2):295-8. https://doi.org/10.4103/0976-0105.103823
6. Won Y. Barriers of Pharmaceutical Care in Community Pharmacies. J Pharma Care Health Sys. 2021;8(S7).
7. World Health Organization. Technical series on primary health care. Integrating health services 2018. https://apps.who.int/iris/bitstream/handle/10665/326459/WHO-HIS-SDS-2018.50-eng.pdf
8. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43.
9. Kaae S, Traulsen JM. Qualitative Methods in Pharmacy Practice Research. Babar ZUD, editor Pharmacy Practice Research Methods. Switzerland: Adis (brand of Springer). 2015;49-68.
10. Gallego G, Norgaard LS. Qualitative Methods in Pharmacy Research. pharmacy. 2018;6(3):79. https://doi.org/10.3390/ pharmacy6030079
11. Ramahlo de Oliveira D, Dupotey NM. La investigación cualitativa. Aplicación de la Atención Farmacéutica. Revista Brasileira de Ciências Farmacêuticas. 2008;44(4):764-9.
12. McCullough MB, Solomon JL, Petrakis BA, Park AM, Ourth H, Morreale AP, Rose A, et al. Balancing Collaborative and Independent Practice Roles in Clinical Pharmacy: A Qualitative Research Study. Annals of Pharmacotherapy. 2015;49(2):189-95. https://doi.org/10.1177/1060028014561473
13. Detoni K, Gonzaga Do Nascimento MM, Oliveira IV, Rodrigues Alves M, Machuca M, Ramalho De Oliveira D. Comprehensive Medication Management services in a brazilian specialty pharmacy: a qualitative assessment. International Journal of Pharmacy and Pharmaceutical Sciences. 2017;9(3):227-32.
14. Low HMM, Yi Feng Lai ZYS. Understanding and expectation towards pharmaceutical care among patients, caregivers and pharmacy service providers: a qualitative study. Eur J Hosp Pharm. 2020;27(1):25-30. https://doi.org/10.1136/ ejhpharm-2017-001415
15. Saw PS, Nissen L, Freeman C, Wong PS, Mak V. A qualitative study on pharmacists’ perception on integrating pharmacists into private general practitioner’s clinics in Malaysia. Pharmacy Practice. 2017;15(3):971. https://doi.org/10.18549/ pharmpract.2017.03.971
16. Hazen ACM, de Bont AA, Leendertse AJ, Zwart DLM, de Wit NJ, de Gier JJ, et al. How Clinical Integration of Pharmacists in General Practice has Impact on Medication Therapy Management: A Theory-oriented Evaluation. Int J Integr Care. 2019;19(1):1. https://doi.org/10.5334/ijic.3291
17. OPS/OMS, Organización Panamericana de la Salud. Conferencia Panamericana de Educación Farmacéutica - informe final 2020 - [Internet]. 2020. https://www.paho.org/es/documentos/conferencia-panamericana-educacion-farmaceutica-informefinal-2020
18. Ministerio de Salud Pública (MINSAP). Manual de Normas y Procedimientos de Farmacia Comunitaria. 1ra ed. La Habana: ECIMED Editorial Ciencias Médicas; 2005.
19. Ministerio de Salud Pública (MINSAP). Manual de Normas y Procedimientos de Farmacia Hospitalaria. 1ra ed. La Habana: ECIMED Editorial Ciencias Médicas; 2005.
20. Ministerio de Salud Pública (MINSAP). Reglamento general de farmacias comunitarias. Resolución no. 88/2016 [Internet]. 2016. https://salud.msp.gob.cu/wp-content/uploads/2019/02/Resoluci%C3%B3n%2088%202016%20MINSAP.pdf
21. Ministerio de Salud Pública (MINSAP). Programa Nacional de Medicamentos. La Habana: ECIMED Editorial Ciencias Médicas; 2014.
22. Reyes I, Cruzata Y, Vidal MF, Bermúdez IB, Nambatya W, Perrand MV, et al. Evaluation of a Standard Operating Procedure for providing Pharmacotherapy follow up to inpatients. Rev Mex Cienc Farm. 2013;44(1):66-78. Cuba.
23. Ortega IL, Couso C, Dupotey NM, Reyes I. Medication approaches potentially inappropriate for the elderly: a Cuban proposal. MEDISAN. 2021;25(1):95-110. Cuba.
24. Cuba MM. Instrumentos para evaluar la calidad en los Servicios Farmacéuticos Hospitalarios cubanos. [dissertation]. [La Habana]: Instituto de Farmacia y Alimentos. Universidad de la Habana; 2013.
25. Medina Y, Labrada A, Morales M, Tur E, Megret R, Dupotey NM. Drug-related problems in pregnant women with anemia from “30 de Noviembre” health area. Orange Journal. 2022;4(8):4-14. Cuba.
26. García D, Rodríguez M, Reyes I, Araya P, Garrido G, Álvarez G, et al. Antimicrobial prescriptions in cancer patients: An evaluation based on clinical and pharmacotherapeutic indicators. J Pharm Pharmacogn Res. 2022;10(3):562-70.
27. Herrera PY, Díaz MM. Potentially inadequate prescriptions in older adults in San Miguel del Padrón municipality, Havana, Cuba. Rev Cubana Farm. 2021;54(1):e508. Cuba.
28. García D, Lores D, Dupotey NM, Espino DL. Pharmaceutical care in hypertensive elderly. An experience in primary health care in Cuba. Ars Pharm. 2018;59(2):91-8. Cuba.
29. Lazo Y, Lores D, Zuñiga CA, Bermudez IB. Preliminary results of the implementation of a pharmacotherapeutic follow-up service in the dispensarized patients with type 2 diabetes mellitus in the main Municipal Pharmacy of Santiago de Cuba. Pharm Care Esp. 2011;13(2):57-65. Cuba.
30. Regueira SM, Rodríguez A, Hidalgo A. [Intervention on Self-medication in the 130 Family Doctors, 2012 year]. Revista Electrónica Dr Zoilo E Marinello Vidaurreta. 2013;38(4). https://revzoilomarinello.sld.cu/index.php/zmv/article/view/587
31. Ortega IL, Reyes I, Dupotey NM, Lores D, Veranes Y, Pupo L, et al. Potentially inappropriate medication in elderly patients in Santiago de Cuba. J Pharm Pharmacogn Res. 2019;7(4):288-96.
32. Rojas E, Dupotey NM, Ramalho De Oliveira D, Carmona D. Tools for a comprehensive approach to patients in pharmaceutical care services in Cuba: design and content validation. Rev Mex Cienc Farm. 2017;48(2):62-82. Cuba.
33. Ortega IL, Dupotey NM, Reyes I, Verdecia ME, Veranes Y, Sagaró NC, et al. Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba. Braz J Pharm Sci. 2017;2:e15215.
34. Fegadolli C, Dupotey NM, Carlini ELA. [Use and abuse of benzodiazepines in primary healthcare: professional practices in Brazil and Cuba]. Cad Saúde Pública. 2019;35(6):e00097718 Brazil.
35. Costa FA, Scullin C, Al-Taani G, Hawwa AF, Anderson C, Bezverhni Z, et al. Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading? J Eval Clin Pract. 2017;23(6):1336-47. https://doi.org/10.1111/ jep.12783
36. ISBE Executive Summary. Pharmacy services in Europe: evaluating trends and value executive summary. [Internet]. PGEU. 2020 [cited 2023 Aug 5]. Available from: https://www.pgeu.eu/publications/isbe-executive-summary/
37. Soares IB, Imfeld-Isenegger TL, Makovec UN, Horvat N, Kos M, Arnet I, et al. A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Research in Social & Administrative Pharmacy [Internet]. 2019; https://doi.org/10.1016/j.sapharm.2019.02.002
38. Huiskes VJB, Burger DM, van den Ende CHM, van den Bemt BJF. Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC Fam Pract. 2017;18(1):5. https://doi.org/10.1186/s12875-016-0577-x
39. Nieuwinckel S, Cornwell S, De Meyer GRY, De Loof H. Hormonal contraception without a prescription: opinions of pharmacists, general practitioners and gynaecologists in Flanders, Belgium. Eur J Contracept Reprod Health Care. 2019;24(2):85-96. https://doi.org/10.1080/13625187.2019.1595574
40. Robberechts A, De Petter C, Van Loon L, Rydant S, Steurbaut S, De Meyer G, et al. Qualitative study of medication review in Flanders, Belgium among community pharmacists and general practitioners. Int J Clin Pharm. 2021;43(5):1173-82. https://doi.org/10.1007/s11096-020-01224-9
41. Robberechts A, Van Loon L, Steurbaut S, De Meyer GRY, De Loof H. Patient experiences and opinions on medication review: a qualitative study. Int J Clin Pharm. 2023;45(3):650-8. https://doi.org/10.1007/s11096-023-01541-9
42. Dupotey NM, Sedeño C, Ramalho De Oliveira D, Rojas EI, Fernández E, Reyes I, et al. Comprenhensive approach in Pharmaceutical Care: Comprehensive Medication Therapy Management Services. Revista Mexicana de Ciencias Farmacéuticas. Asociación Farmacéutica Mexicana, A.C. 2017;48(4):28-42.
43. Rosenthal M. Qualitative research methods: Why, when, and how to conduct interviews and focus groups in pharmacy research. Currents in Pharmacy Teaching and Learning. 2016;8(4):509-16.
44. Robberechts A, De Petter C, Van Loon L, Rydant S, Steurbaut S, De Meyer G, et al. Qualitative study of medication review in Flanders, Belgium among community pharmacists and general practitioners. Int J Clin Pharm. 2021;43(5):1173-82. https://doi.org/10.1007/s11096-020-01224-9
45. Do Amaral PA, Mendonça SAM, Ramalho De Oliveira D, Peloso LJ, Dos Santos R, Ribeiro MA. Impact of a medication therapymanagement service offered to patients in treatment of breast cancer. Braz J Pharm Sci. 2018;54(2).
46. Caulfield, J. How to Do Thematic Analysis | Step-by- Step Guide & Examples. [Internet]. 2023 [cited 2023 Aug 5]. Available from: https://www.scribbr.com/methodology/thematic-analysis/
47. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3:77-101.
48. Mateu L, Estarda V, Sedeño C, Arbesú MA. Strategy of knowledge managements for the Cuban pharmaceutical services. Revista Cubana de Farmacia. 2021;54(2):e576.
49. Magedanz L. Implantação do serviço de farmácia clínica em hospitais públicos do Distrito Federal, Brasil [dissertation]. Brasília: Universidade de Brasília; 2020.
50. Ghibu S, Juncan AM, Rus LL, Frum A, Dobrea CM, Chiş AA, et al. The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(18):9776. https://doi.org/10.3390/ijerph18189776
51. Kharaba Z, Moutraji SA, Al Khawaldeh RA, Alfoteih Y, Al Meslamani AZ. What has changed in the pharmaceutical care after COVID-19: Pharmacists’ perspective. Pharmacy Practice. 2022;20(2):2656. https://doi.org/10.18549/pharmpract.2022.2.2656
52. 1 st MAY 2006. - Law amending Royal Decree no. 78 of 10 November 1967 relating to the exercise of health care professions. [Internet]. ELI Navigation system by European legislation identifier.Federal Public Service Health, Food Chain Safety and Environment. [cited 2023 Aug 5]. Available from: http://www.ejustice.just.fgov.be/eli/loi/2006/05/01/2006022637/moniteur
53. Boogaerts T, De Swert C, Covaci A, van Nuijs ALN, Hamelinck W, Saevels J, et al. Out of pocket expenses: effect of fee-waivers on opioid prescribing and dispensing. Int J Drug Policy. 2021;98:103423. https://doi.org/10.1016/j.drugpo.2021.103423
54. De Loof H, De Win E, Moens N, Verhoeven V, Van Royen P, Kreps EO, et al. Overprescribing of Topical Ocular Corticosteroids and Antibiotics in Out-of-Hours Primary Care in Belgium. Drug Healthc Patient Saf. 2021;13:229-32. https://doi.org/10.2147/ dhps.s339141
55. Dupotey NM. Paradigma de Atención Farmacéutica con enfoque holístico [dissertation]. [La Habana]: Instituto de Farmacia y Alimentos. Universidad de la Habana; 2013.
56. Reyes I, Bermúdez IB. Social contradictions in Pharmaceutical Care practice at hospital setting in Cuba. Revista Cubana de Farmacia. 2012;46(2):213-23. Cuba.
57. Lelubre M, Wuyts J, Maesschalck J, Duquet N, Foubert K, Hutsebaut C, et al. Implementation study of an intermediate medication review in Belgian community pharmacies. Res Social Adm Pharm. 2019;15(6):710-23. https://doi.org/10.1016/j. sapharm.2018.09.002
58. De Bock L, Tommelein E, Baekelandt H, Maes W, Boussery K, Somers A. The Introduction of a Full Medication Review Process in a Local Hospital: Successes and Barriers of a Pilot Project in the Geriatric Ward. Pharmacy. Multidisciplinary Digital Publishing Institute; 2018;6(1):21. https://doi.org/10.3390/pharmacy6010021
59. Debesa F, Viña G. [Pharmaceutical Services based on the primary health care, a new paradigm for the pharmaceutical professional]. Revista Cubana de Farmacia [Internet]. 2017 [cited 2023 Aug 5];51(1). Available from: https://revfarmacia.sld.cu/index.php/far/article/view/189
60. Schommer JC. Pharmacist workload and time management. [Internet]. DugTopics. 2001. Available from: https://www. drugtopics.com/view/pharmacist-workload-and-time-management
61. Sun Q, Wan Ch, Xu Zh, Huang Y, Xi X. Association of pharmaceutical care barriers and role ambiguity and role conflict of clinical pharmacists. Frontiers in Pharmacology. 2023;14:1103255. https://doi.org/10.3389/fphar.2023.1103255
62. Shrestha R, Palaian S, Sapkota B, Shrestha S, Khatiwada AP, Shankar PR. A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal. natureportfolio. 2022;12:16590. https://doi.org/10.1038/s41598-022-16653-x
63. Elías I, García A, Besga RR, Rouco M. Basic structural conditions for the implementation of pharmacotherapeutic follow-up in Cuban community pharmacies. Revista Cubana de Farmacia. 2019;52(4. Cuba).
64. Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract. 2014;22(4):292-9. https://doi.org/10.1111/ijpp.12080
65. Law on Patients’ Rights [Internet]. FPS Public Health, Food Chain Safety and Enviroment. 2007. Available from: https://www. health.belgium.be/en/health/taking-care-yourself/patient-related-themes/patients-rights/what-rights-do-patients-have
66. Araújo FC, Onozato T, Alcântara TDS, Santana A, Souza DC, Machado DM, et al. Barreiras Percebidas por um Grupo de Farmacêuticos Antes e Após a Implantação da Farmácia Clínica em um Hospital Público de Alta Complexidade. Rev Bras Farm Hosp Serv Saúde São Paulo. 2017;8(2):141.
67. Kempen TGH, Kälvemark A, Sawires M, Stewart D, Gillespie U. Facilitators and barriers for performing comprehensive medication reviews and follow-up by multiprofessional teams in older hospitalised patients. Eur J Clin Pharmacol. 2020;76(6):775-84. https://doi.org/10.1007/s00228-020-02846-8
68. Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Van Royen P, Pype P, et al. Development of a toolkit to improve interprofessional collaboration and integration in primary care using qualitative interviews and co-design workshops. Front Public Health. 2023;11:1140987. https://doi.org/10.3389/fpubh.2023.1140987
69. Pharmaceutical Group of European Union PGEU. eHealth Solutions in European Community Pharmacies: Annex [Internet]. 2016 [cited 2023 Aug 17]. Available from: https://www.pgeu.eu/wp-content/uploads/2019/07/161102E-PGEU-Statement-on eHealth-ANNEX-Final.pdf
70. Brazinha I, Fernandez-Llimos F. Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Int J Clin Pharm. 2014;36(5):1031-8. https://doi.org/10.1007/s11096-014-9991-0
71. Mihaylova A, Hadzhieva B, Argilashki D, Kasnakova P, Gueorguieva E, Gueorguiev S, et al. Bulgarian pharmacists’ attitudes and barriers towards Pharmaceutical Care provision for increasing immunity in children. FARMACIA. 2023;71(2).
72. Dylst P, Vulto A, Simoens S. How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing? Pharmacy Practice. 2012;10(1):3-8. https://doi.org/10.4321/s1886-36552012000100002
73. Alvarez A, Turpo A, Ortiz L, Gongora N, Del-Aguila S. Barriers to the implementation of pharmaceutical care in pharmacies in Cusco, Peru. Pharm Care Esp. 2016;18(5):194-205.
74. Moinier X, Bonnal L. Satisfaction and loyalty of the Pharmacy customers: a public health issue. Review Gestion & Management public. 2019;7(4):51-68.
75. Teichert M, Schoenmakers T, Kylstra N, Mosk B, Bouvy ML, van de Vaart F, et al. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies. Int J Clin Pharm. 2016;38(4):870-9. https://doi.org/10.1007/s11096-016-0301-x
76. Cillis M, Spinewine A, Krug B, Quennery S, Wouters D, Dalleur O. Development of a tool for benchmarking of clinical pharmacy activities. International Journal of Clinical Pharmacy. 2018;40(6):1462-73. https://doi.org/10.1007/s11096-018-0725-6
77. Bring Y, Reyes I, Morales M, Bermúdez IB, López M, Téllez AM, et al. Quality indicators Pharmacotherapy follow-up service to hospitalized patients with psychiatric disorders. Revista Mexicana de Ciencias Farmacéuticas. 2016;47(2):51-9.
78. Ravela R, Airaksinen M, Lyles A. State of the European Union’s early notification obligation for drug shortages: enforcement and compliance in eight European countries (2020-2022). Journal of Pharmaceutical Policy and Practice [Internet]. 2023;16(1):135. Available from: https://doi.org/10.1186/s40545-023-00646-w
79. The Belgian Royal Decree concerning drug shortages [Internet]. iethico. [cited 2023 Nov 17]. https://iethico.com/blog/f/thebelgian- royal-decree-concerning-drug-shortages
80. Robberechts A, Michielsen M, Steurbaut S, De Meyer GRY, De Loof H. Key elements in the quality assessment of a type 3 medication review. Frontiers in Pharmacology. 2023;14:1258364. https://doi.org/10.3389/fphar.2023.1258364
81. Rens E, Scheepers J, Foulon V, Hutsebaut C, Ghijselings A, Van Den Broeck K. Building Bridges between Pharmacy and Psychosocial Care: Supporting and Referring Patients with Psychosocial Needs in a Pilot Study with Community Pharmacists. International Journal of Integrated Care [Internet]. 2023;23(3):15. https://doi.org/10.5334/ijic.7531
82. García AJ, López L, Pría MC, León P. Drug consumption and living conditions. Revista Cubana de Salud Pública. 2016;42(3):442-50.
2. Almarsdóttir AB, Granas AG, Blondal AB. Chapter 3 - Clinical and Social Perspectives on Pharmacy Services. In: Thomas D,
editor. Clinical Pharmacy Education, Practice and Research. Elsevier; 2019;31-40. https://www.sciencedirect.com/science/article/pii/B9780128142769000039
3. Lugo GB, Concepción Z, Aguilar-Rabito A, Samaniego LR, Maidana de Larroza GM. Barriers that prevent effective implementation of Pharmaceutical Care. Ars Pharm. 2019;60(4):199-204. Spain.
4. Van Mil JWF, De Boer W0, Tromp THFJ. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract.2001;9:163-8.
5. Okonta JM, Okonta EO, Ofoegbu TC. Barriers to Implementation of Pharmaceutical Care by Pharmacists in Nsukka and Enugu metropolis of Enugu State. J Basic Clin Pharm. 2012;3(2):295-8. https://doi.org/10.4103/0976-0105.103823
6. Won Y. Barriers of Pharmaceutical Care in Community Pharmacies. J Pharma Care Health Sys. 2021;8(S7).
7. World Health Organization. Technical series on primary health care. Integrating health services 2018. https://apps.who.int/iris/bitstream/handle/10665/326459/WHO-HIS-SDS-2018.50-eng.pdf
8. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43.
9. Kaae S, Traulsen JM. Qualitative Methods in Pharmacy Practice Research. Babar ZUD, editor Pharmacy Practice Research Methods. Switzerland: Adis (brand of Springer). 2015;49-68.
10. Gallego G, Norgaard LS. Qualitative Methods in Pharmacy Research. pharmacy. 2018;6(3):79. https://doi.org/10.3390/ pharmacy6030079
11. Ramahlo de Oliveira D, Dupotey NM. La investigación cualitativa. Aplicación de la Atención Farmacéutica. Revista Brasileira de Ciências Farmacêuticas. 2008;44(4):764-9.
12. McCullough MB, Solomon JL, Petrakis BA, Park AM, Ourth H, Morreale AP, Rose A, et al. Balancing Collaborative and Independent Practice Roles in Clinical Pharmacy: A Qualitative Research Study. Annals of Pharmacotherapy. 2015;49(2):189-95. https://doi.org/10.1177/1060028014561473
13. Detoni K, Gonzaga Do Nascimento MM, Oliveira IV, Rodrigues Alves M, Machuca M, Ramalho De Oliveira D. Comprehensive Medication Management services in a brazilian specialty pharmacy: a qualitative assessment. International Journal of Pharmacy and Pharmaceutical Sciences. 2017;9(3):227-32.
14. Low HMM, Yi Feng Lai ZYS. Understanding and expectation towards pharmaceutical care among patients, caregivers and pharmacy service providers: a qualitative study. Eur J Hosp Pharm. 2020;27(1):25-30. https://doi.org/10.1136/ ejhpharm-2017-001415
15. Saw PS, Nissen L, Freeman C, Wong PS, Mak V. A qualitative study on pharmacists’ perception on integrating pharmacists into private general practitioner’s clinics in Malaysia. Pharmacy Practice. 2017;15(3):971. https://doi.org/10.18549/ pharmpract.2017.03.971
16. Hazen ACM, de Bont AA, Leendertse AJ, Zwart DLM, de Wit NJ, de Gier JJ, et al. How Clinical Integration of Pharmacists in General Practice has Impact on Medication Therapy Management: A Theory-oriented Evaluation. Int J Integr Care. 2019;19(1):1. https://doi.org/10.5334/ijic.3291
17. OPS/OMS, Organización Panamericana de la Salud. Conferencia Panamericana de Educación Farmacéutica - informe final 2020 - [Internet]. 2020. https://www.paho.org/es/documentos/conferencia-panamericana-educacion-farmaceutica-informefinal-2020
18. Ministerio de Salud Pública (MINSAP). Manual de Normas y Procedimientos de Farmacia Comunitaria. 1ra ed. La Habana: ECIMED Editorial Ciencias Médicas; 2005.
19. Ministerio de Salud Pública (MINSAP). Manual de Normas y Procedimientos de Farmacia Hospitalaria. 1ra ed. La Habana: ECIMED Editorial Ciencias Médicas; 2005.
20. Ministerio de Salud Pública (MINSAP). Reglamento general de farmacias comunitarias. Resolución no. 88/2016 [Internet]. 2016. https://salud.msp.gob.cu/wp-content/uploads/2019/02/Resoluci%C3%B3n%2088%202016%20MINSAP.pdf
21. Ministerio de Salud Pública (MINSAP). Programa Nacional de Medicamentos. La Habana: ECIMED Editorial Ciencias Médicas; 2014.
22. Reyes I, Cruzata Y, Vidal MF, Bermúdez IB, Nambatya W, Perrand MV, et al. Evaluation of a Standard Operating Procedure for providing Pharmacotherapy follow up to inpatients. Rev Mex Cienc Farm. 2013;44(1):66-78. Cuba.
23. Ortega IL, Couso C, Dupotey NM, Reyes I. Medication approaches potentially inappropriate for the elderly: a Cuban proposal. MEDISAN. 2021;25(1):95-110. Cuba.
24. Cuba MM. Instrumentos para evaluar la calidad en los Servicios Farmacéuticos Hospitalarios cubanos. [dissertation]. [La Habana]: Instituto de Farmacia y Alimentos. Universidad de la Habana; 2013.
25. Medina Y, Labrada A, Morales M, Tur E, Megret R, Dupotey NM. Drug-related problems in pregnant women with anemia from “30 de Noviembre” health area. Orange Journal. 2022;4(8):4-14. Cuba.
26. García D, Rodríguez M, Reyes I, Araya P, Garrido G, Álvarez G, et al. Antimicrobial prescriptions in cancer patients: An evaluation based on clinical and pharmacotherapeutic indicators. J Pharm Pharmacogn Res. 2022;10(3):562-70.
27. Herrera PY, Díaz MM. Potentially inadequate prescriptions in older adults in San Miguel del Padrón municipality, Havana, Cuba. Rev Cubana Farm. 2021;54(1):e508. Cuba.
28. García D, Lores D, Dupotey NM, Espino DL. Pharmaceutical care in hypertensive elderly. An experience in primary health care in Cuba. Ars Pharm. 2018;59(2):91-8. Cuba.
29. Lazo Y, Lores D, Zuñiga CA, Bermudez IB. Preliminary results of the implementation of a pharmacotherapeutic follow-up service in the dispensarized patients with type 2 diabetes mellitus in the main Municipal Pharmacy of Santiago de Cuba. Pharm Care Esp. 2011;13(2):57-65. Cuba.
30. Regueira SM, Rodríguez A, Hidalgo A. [Intervention on Self-medication in the 130 Family Doctors, 2012 year]. Revista Electrónica Dr Zoilo E Marinello Vidaurreta. 2013;38(4). https://revzoilomarinello.sld.cu/index.php/zmv/article/view/587
31. Ortega IL, Reyes I, Dupotey NM, Lores D, Veranes Y, Pupo L, et al. Potentially inappropriate medication in elderly patients in Santiago de Cuba. J Pharm Pharmacogn Res. 2019;7(4):288-96.
32. Rojas E, Dupotey NM, Ramalho De Oliveira D, Carmona D. Tools for a comprehensive approach to patients in pharmaceutical care services in Cuba: design and content validation. Rev Mex Cienc Farm. 2017;48(2):62-82. Cuba.
33. Ortega IL, Dupotey NM, Reyes I, Verdecia ME, Veranes Y, Sagaró NC, et al. Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba. Braz J Pharm Sci. 2017;2:e15215.
34. Fegadolli C, Dupotey NM, Carlini ELA. [Use and abuse of benzodiazepines in primary healthcare: professional practices in Brazil and Cuba]. Cad Saúde Pública. 2019;35(6):e00097718 Brazil.
35. Costa FA, Scullin C, Al-Taani G, Hawwa AF, Anderson C, Bezverhni Z, et al. Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading? J Eval Clin Pract. 2017;23(6):1336-47. https://doi.org/10.1111/ jep.12783
36. ISBE Executive Summary. Pharmacy services in Europe: evaluating trends and value executive summary. [Internet]. PGEU. 2020 [cited 2023 Aug 5]. Available from: https://www.pgeu.eu/publications/isbe-executive-summary/
37. Soares IB, Imfeld-Isenegger TL, Makovec UN, Horvat N, Kos M, Arnet I, et al. A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Research in Social & Administrative Pharmacy [Internet]. 2019; https://doi.org/10.1016/j.sapharm.2019.02.002
38. Huiskes VJB, Burger DM, van den Ende CHM, van den Bemt BJF. Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC Fam Pract. 2017;18(1):5. https://doi.org/10.1186/s12875-016-0577-x
39. Nieuwinckel S, Cornwell S, De Meyer GRY, De Loof H. Hormonal contraception without a prescription: opinions of pharmacists, general practitioners and gynaecologists in Flanders, Belgium. Eur J Contracept Reprod Health Care. 2019;24(2):85-96. https://doi.org/10.1080/13625187.2019.1595574
40. Robberechts A, De Petter C, Van Loon L, Rydant S, Steurbaut S, De Meyer G, et al. Qualitative study of medication review in Flanders, Belgium among community pharmacists and general practitioners. Int J Clin Pharm. 2021;43(5):1173-82. https://doi.org/10.1007/s11096-020-01224-9
41. Robberechts A, Van Loon L, Steurbaut S, De Meyer GRY, De Loof H. Patient experiences and opinions on medication review: a qualitative study. Int J Clin Pharm. 2023;45(3):650-8. https://doi.org/10.1007/s11096-023-01541-9
42. Dupotey NM, Sedeño C, Ramalho De Oliveira D, Rojas EI, Fernández E, Reyes I, et al. Comprenhensive approach in Pharmaceutical Care: Comprehensive Medication Therapy Management Services. Revista Mexicana de Ciencias Farmacéuticas. Asociación Farmacéutica Mexicana, A.C. 2017;48(4):28-42.
43. Rosenthal M. Qualitative research methods: Why, when, and how to conduct interviews and focus groups in pharmacy research. Currents in Pharmacy Teaching and Learning. 2016;8(4):509-16.
44. Robberechts A, De Petter C, Van Loon L, Rydant S, Steurbaut S, De Meyer G, et al. Qualitative study of medication review in Flanders, Belgium among community pharmacists and general practitioners. Int J Clin Pharm. 2021;43(5):1173-82. https://doi.org/10.1007/s11096-020-01224-9
45. Do Amaral PA, Mendonça SAM, Ramalho De Oliveira D, Peloso LJ, Dos Santos R, Ribeiro MA. Impact of a medication therapymanagement service offered to patients in treatment of breast cancer. Braz J Pharm Sci. 2018;54(2).
46. Caulfield, J. How to Do Thematic Analysis | Step-by- Step Guide & Examples. [Internet]. 2023 [cited 2023 Aug 5]. Available from: https://www.scribbr.com/methodology/thematic-analysis/
47. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3:77-101.
48. Mateu L, Estarda V, Sedeño C, Arbesú MA. Strategy of knowledge managements for the Cuban pharmaceutical services. Revista Cubana de Farmacia. 2021;54(2):e576.
49. Magedanz L. Implantação do serviço de farmácia clínica em hospitais públicos do Distrito Federal, Brasil [dissertation]. Brasília: Universidade de Brasília; 2020.
50. Ghibu S, Juncan AM, Rus LL, Frum A, Dobrea CM, Chiş AA, et al. The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(18):9776. https://doi.org/10.3390/ijerph18189776
51. Kharaba Z, Moutraji SA, Al Khawaldeh RA, Alfoteih Y, Al Meslamani AZ. What has changed in the pharmaceutical care after COVID-19: Pharmacists’ perspective. Pharmacy Practice. 2022;20(2):2656. https://doi.org/10.18549/pharmpract.2022.2.2656
52. 1 st MAY 2006. - Law amending Royal Decree no. 78 of 10 November 1967 relating to the exercise of health care professions. [Internet]. ELI Navigation system by European legislation identifier.Federal Public Service Health, Food Chain Safety and Environment. [cited 2023 Aug 5]. Available from: http://www.ejustice.just.fgov.be/eli/loi/2006/05/01/2006022637/moniteur
53. Boogaerts T, De Swert C, Covaci A, van Nuijs ALN, Hamelinck W, Saevels J, et al. Out of pocket expenses: effect of fee-waivers on opioid prescribing and dispensing. Int J Drug Policy. 2021;98:103423. https://doi.org/10.1016/j.drugpo.2021.103423
54. De Loof H, De Win E, Moens N, Verhoeven V, Van Royen P, Kreps EO, et al. Overprescribing of Topical Ocular Corticosteroids and Antibiotics in Out-of-Hours Primary Care in Belgium. Drug Healthc Patient Saf. 2021;13:229-32. https://doi.org/10.2147/ dhps.s339141
55. Dupotey NM. Paradigma de Atención Farmacéutica con enfoque holístico [dissertation]. [La Habana]: Instituto de Farmacia y Alimentos. Universidad de la Habana; 2013.
56. Reyes I, Bermúdez IB. Social contradictions in Pharmaceutical Care practice at hospital setting in Cuba. Revista Cubana de Farmacia. 2012;46(2):213-23. Cuba.
57. Lelubre M, Wuyts J, Maesschalck J, Duquet N, Foubert K, Hutsebaut C, et al. Implementation study of an intermediate medication review in Belgian community pharmacies. Res Social Adm Pharm. 2019;15(6):710-23. https://doi.org/10.1016/j. sapharm.2018.09.002
58. De Bock L, Tommelein E, Baekelandt H, Maes W, Boussery K, Somers A. The Introduction of a Full Medication Review Process in a Local Hospital: Successes and Barriers of a Pilot Project in the Geriatric Ward. Pharmacy. Multidisciplinary Digital Publishing Institute; 2018;6(1):21. https://doi.org/10.3390/pharmacy6010021
59. Debesa F, Viña G. [Pharmaceutical Services based on the primary health care, a new paradigm for the pharmaceutical professional]. Revista Cubana de Farmacia [Internet]. 2017 [cited 2023 Aug 5];51(1). Available from: https://revfarmacia.sld.cu/index.php/far/article/view/189
60. Schommer JC. Pharmacist workload and time management. [Internet]. DugTopics. 2001. Available from: https://www. drugtopics.com/view/pharmacist-workload-and-time-management
61. Sun Q, Wan Ch, Xu Zh, Huang Y, Xi X. Association of pharmaceutical care barriers and role ambiguity and role conflict of clinical pharmacists. Frontiers in Pharmacology. 2023;14:1103255. https://doi.org/10.3389/fphar.2023.1103255
62. Shrestha R, Palaian S, Sapkota B, Shrestha S, Khatiwada AP, Shankar PR. A nationwide exploratory survey assessing perception, practice, and barriers toward pharmaceutical care provision among hospital pharmacists in Nepal. natureportfolio. 2022;12:16590. https://doi.org/10.1038/s41598-022-16653-x
63. Elías I, García A, Besga RR, Rouco M. Basic structural conditions for the implementation of pharmacotherapeutic follow-up in Cuban community pharmacies. Revista Cubana de Farmacia. 2019;52(4. Cuba).
64. Jorgenson D, Laubscher T, Lyons B, Palmer R. Integrating pharmacists into primary care teams: barriers and facilitators. Int J Pharm Pract. 2014;22(4):292-9. https://doi.org/10.1111/ijpp.12080
65. Law on Patients’ Rights [Internet]. FPS Public Health, Food Chain Safety and Enviroment. 2007. Available from: https://www. health.belgium.be/en/health/taking-care-yourself/patient-related-themes/patients-rights/what-rights-do-patients-have
66. Araújo FC, Onozato T, Alcântara TDS, Santana A, Souza DC, Machado DM, et al. Barreiras Percebidas por um Grupo de Farmacêuticos Antes e Após a Implantação da Farmácia Clínica em um Hospital Público de Alta Complexidade. Rev Bras Farm Hosp Serv Saúde São Paulo. 2017;8(2):141.
67. Kempen TGH, Kälvemark A, Sawires M, Stewart D, Gillespie U. Facilitators and barriers for performing comprehensive medication reviews and follow-up by multiprofessional teams in older hospitalised patients. Eur J Clin Pharmacol. 2020;76(6):775-84. https://doi.org/10.1007/s00228-020-02846-8
68. Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Van Royen P, Pype P, et al. Development of a toolkit to improve interprofessional collaboration and integration in primary care using qualitative interviews and co-design workshops. Front Public Health. 2023;11:1140987. https://doi.org/10.3389/fpubh.2023.1140987
69. Pharmaceutical Group of European Union PGEU. eHealth Solutions in European Community Pharmacies: Annex [Internet]. 2016 [cited 2023 Aug 17]. Available from: https://www.pgeu.eu/wp-content/uploads/2019/07/161102E-PGEU-Statement-on eHealth-ANNEX-Final.pdf
70. Brazinha I, Fernandez-Llimos F. Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Int J Clin Pharm. 2014;36(5):1031-8. https://doi.org/10.1007/s11096-014-9991-0
71. Mihaylova A, Hadzhieva B, Argilashki D, Kasnakova P, Gueorguieva E, Gueorguiev S, et al. Bulgarian pharmacists’ attitudes and barriers towards Pharmaceutical Care provision for increasing immunity in children. FARMACIA. 2023;71(2).
72. Dylst P, Vulto A, Simoens S. How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing? Pharmacy Practice. 2012;10(1):3-8. https://doi.org/10.4321/s1886-36552012000100002
73. Alvarez A, Turpo A, Ortiz L, Gongora N, Del-Aguila S. Barriers to the implementation of pharmaceutical care in pharmacies in Cusco, Peru. Pharm Care Esp. 2016;18(5):194-205.
74. Moinier X, Bonnal L. Satisfaction and loyalty of the Pharmacy customers: a public health issue. Review Gestion & Management public. 2019;7(4):51-68.
75. Teichert M, Schoenmakers T, Kylstra N, Mosk B, Bouvy ML, van de Vaart F, et al. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies. Int J Clin Pharm. 2016;38(4):870-9. https://doi.org/10.1007/s11096-016-0301-x
76. Cillis M, Spinewine A, Krug B, Quennery S, Wouters D, Dalleur O. Development of a tool for benchmarking of clinical pharmacy activities. International Journal of Clinical Pharmacy. 2018;40(6):1462-73. https://doi.org/10.1007/s11096-018-0725-6
77. Bring Y, Reyes I, Morales M, Bermúdez IB, López M, Téllez AM, et al. Quality indicators Pharmacotherapy follow-up service to hospitalized patients with psychiatric disorders. Revista Mexicana de Ciencias Farmacéuticas. 2016;47(2):51-9.
78. Ravela R, Airaksinen M, Lyles A. State of the European Union’s early notification obligation for drug shortages: enforcement and compliance in eight European countries (2020-2022). Journal of Pharmaceutical Policy and Practice [Internet]. 2023;16(1):135. Available from: https://doi.org/10.1186/s40545-023-00646-w
79. The Belgian Royal Decree concerning drug shortages [Internet]. iethico. [cited 2023 Nov 17]. https://iethico.com/blog/f/thebelgian- royal-decree-concerning-drug-shortages
80. Robberechts A, Michielsen M, Steurbaut S, De Meyer GRY, De Loof H. Key elements in the quality assessment of a type 3 medication review. Frontiers in Pharmacology. 2023;14:1258364. https://doi.org/10.3389/fphar.2023.1258364
81. Rens E, Scheepers J, Foulon V, Hutsebaut C, Ghijselings A, Van Den Broeck K. Building Bridges between Pharmacy and Psychosocial Care: Supporting and Referring Patients with Psychosocial Needs in a Pilot Study with Community Pharmacists. International Journal of Integrated Care [Internet]. 2023;23(3):15. https://doi.org/10.5334/ijic.7531
82. García AJ, López L, Pría MC, León P. Drug consumption and living conditions. Revista Cubana de Salud Pública. 2016;42(3):442-50.
Article Sidebar
Published
Mar 26, 2025
Article Details
How to Cite
1.
Pharmaceutical Care provision from the pharmacist’s perspective: a qualitative study in Belgian and Cuban contexts. Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Apr. 21];23(1):1-33. Available from: https://pharmacypractice.org/index.php/pp/article/view/3042
Section
Original Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
1.
Pharmaceutical Care provision from the pharmacist’s perspective: a qualitative study in Belgian and Cuban contexts. Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Apr. 21];23(1):1-33. Available from: https://pharmacypractice.org/index.php/pp/article/view/3042