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Development of a decision support system for the practice of responsible self-medication

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Abstract

Background Responsible self-medication is an integral part of the health system that consists of community pharmacists counseling patients on treating minor illness using non-prescription medications. Systems for properly managing information can assist disease identification and clinical decision-making. Objective To develop a software program to assist community pharmacists in clinical decision-making regarding selfmedication. Setting The study was conducted in northeastern Brazil. Methods The study was conducted from February 2012 to January 2014. System development included identifying minor illnesses commonly treated by community pharmacists and creating simulations of community pharmacies using a simulated patient methodology. Clinical pharmacists, production engineering students, professors, and a pharmacist researcher comprised the development group. Five meetings were held to develop the software, and the system was completed in December 2013. Main outcome measure Minor illnesses commonly treated by community pharmacists, and simulated patient methodology. Results In the first meeting the final list of topics for inclusion in the algorithm indicated the exact questions to be addressed by the community pharmacist to properly manage the complaint. In the second meeting, the discussions in the focus group indicated consensus among pharmacists as to the medications on the list of Groups and Specified Therapeutic Indications of Brazilian Legislation. In the third meeting were defined the parameters to refer patients to the doctor. In the fourth meeting the algorithm was tested using a simulated patient, to observe whether the question order ensures an effective, efficient, and safe decision process for the patient. In the fifth meeting, the algorithm was tested again using a simulated patient with the flu, and all group members agreed upon its final incarnation after refinements to the situations that determined referral to the doctor. Conclusion The software may contribute to identifying health risk situations (potentially unsafe medications based on clinical history, clinical hazards, and past adverse events) requiring medical treatment.

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References

  1. Sedighi B, Ghaderi-Sohi S, Emami S. Evaluation of self-medication prevalence, diagnosis and prescription in migraine in Kerman, Iran. Saudi Med J. 2006;27(3):377–80.

    PubMed  Google Scholar 

  2. Kagashe GA, Minzi O, Matowe L. An assessment of dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania. Int J Pharm Pract. 2011;19(1):30–5.

    Article  PubMed  Google Scholar 

  3. Hussain A, Ibrahim MI. Management of diarrhoea cases by community pharmacies in 3 cities of Pakistan. East Mediterr Health J. 2012;18(6):635–40.

    CAS  PubMed  Google Scholar 

  4. Pham DM, Byrkit M, Pham HV, Pham T, Nguyen CT. Improving pharmacy staff knowledge and practice on childhood diarrhea management in Vietnam: are educational interventions effective? PLoS One. 2013;8(10):e74882.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Brabers AEML, Van Dijk L, Bouvy ML, De Jong JD. Where to buy OTC medications? A cross-sectional survey investigating consumers’ confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers. BMJ Open. 2013;3(9):e003455.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P, et al. Perceptions and practices of self-medication among medical students in coastal South India. PLoS One. 2013;8(8):e72247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. National Association of Chain Drug Stores (NACDS). Chain pharmacy industry profile illustrates pharmacy value [cited 2013 Dec 21]. 2010–2011. http://drugtopics.modernmedicine.com/drug-topics/news/modernmedicine/modern-medicine-news/nacds-2010-2011-chain-pharmacy-industry-profile?page=full.

  8. Sommers JP. Prescription drug expenditures in the 10 largest states for persons under age 65. Rockville, MD: Agency for Healthcare Research and Quality [cited 2014 Dec 21]. 2005. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st196/stat196.pdf.

  9. Patient-Centered Primary Care Collaborative. The patient-centered medical home: integrating comprehensive medication management to optimize patient outcomes. Washington, DC: American College of Clinical Pharmacy; 2012.

    Google Scholar 

  10. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192–9.

    Article  CAS  Google Scholar 

  11. Kaiser Family Foundation. Prescription drug trends. Washington, DC: KFF, 2010 [cited 2013 Dec 21]. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/3057-08.pdf.

  12. Rottenkolber D, Schmiedl S, Rottenkolber M, Farker K, Saljé K, Mueller S, et al. Net of Regional Pharmacovigilance Centers. Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations. Pharmacoepidemiol Drug Saf. 2011;20(6):626–34.

    Article  PubMed  Google Scholar 

  13. Automedicação no Brasil. Guia da Farmácia - Maio/2014 [cited 2013 Dec 21]. http://crf-rj.org.br/noticias/434-automedicacao-no-brasil.html.

  14. Cuzzolin L, Benoni G. Safety of non-prescription medicines: knowledge and attitudes of Italian pharmacy customers. Pharm World Sci. 2010;32:97–102.

    Article  PubMed  Google Scholar 

  15. Eickhoff C, Hämmerlein A, Griese N, et al. Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol Drug Saf. 2012;21:254–60.

    Article  PubMed  Google Scholar 

  16. Rocha CE, Bispo ML, Alcantara TS, et al. What do brazilian community pharmacists know about self-medication for minor illnesses? A pilot study in the northeast of Brazil. J Appl Pharm Sci. 2014;4:12–20.

    Google Scholar 

  17. World Health Organization (WHO). The role of the pharmacist in self-care and self-medication. Report of the 4th WHO consultative group on the role of the pharmacist. WHO/DAP/98.13 [cited 2014 Feb 27]. 1998. http://apps.who.int/medicinedocs/pdf/whozip32e/whozip32e.pdf.

  18. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Remon JP, De Looze D. Self-medication of upper gastrointestinal symptoms: a community pharmacy study. Ann Pharmacother. 2009;43(5):890–8.

    PubMed  Google Scholar 

  19. Hanna LA, Hughes CM. ‘First, do no harm’: factors that influence pharmacists making decisions about over-the-counter medication: a qualitative study in Northern Ireland. Drug Saf. 2010;33(3):245–55.

    Article  PubMed  Google Scholar 

  20. Piecuch A, Kozłowska-Wojciechowska M. Self-medication in Poland: the pharmacist’s advisory role in Warsaw. Int J Clin Pharm. 2013;35:225–9.

    Article  PubMed  Google Scholar 

  21. Turban E. Administração de Tecnologia da Informação “Teoria & Pratica”. Rio de Janeiro: Elsevier; 2005. ISBN: 8535215719 9788535215717.

  22. Aradottir HAE, Kinnear M. Design of an algorithm to support community pharmacy dyspepsia management. Pharm World Sci. 2008;30:515–25.

    Article  PubMed  Google Scholar 

  23. Mañas AV. Administração de Sistemas de Informação “Como otimizar a empresa por meio dos sistemas de informação”.São Paulo: Érica; 2010. ISBN: 9788571946354.

  24. Al-Eidana FA, McElnaya JC, Scottb MG, Kearneyc MP, Corrigand J, McConnelld JB. Use of a treatment protocol in the management of community-acquired lower respiratory tract infection. J Antimicrob Chemother. 2000;45:387–94.

    Article  Google Scholar 

  25. Mohan NN, Nagavi BG. Development of standard therapeutic guidelines for selected common diseases for the primary health care centres of a South Indian district. Int J Pharm Pract. 2003;11:169–74.

    Article  Google Scholar 

  26. Savi MGM, Silva EL. O uso da informação e a prática clínica de médicos residentes. Perspect Ciênc Inf. 2011;16(3):232–54.

    Article  Google Scholar 

  27. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clinician’s guide. 2nd ed. New York, NY: McGraw-Hill; 2004. ISBN 9780071362597.

    Google Scholar 

  28. García Molina JF, Zheng L, Sertdemir M, Dinter DJ, Schönberg S, Rädle M. Incremental learning with SVM for multimodal classification of prostatic adenocarcinoma. PLoS One. 2014;9(4):e93600.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lynskey D, Haigh S, Patel N, Macadam A. Medication errors in community pharmacy: an investigation into the types and potential causes. Int J Pharm Pract. 2007;15:105–12.

    Article  Google Scholar 

  30. Holtmann G, Bigard MA, Malfertheiner P, Pounder R. Guidance on the use of over-the-counter proton pump inhibitors for the treatment of GERD. Int J Clin Pharm. 2011;33:493–500.

    Article  CAS  PubMed  Google Scholar 

  31. Saverno KR, Hines LE, Warholak TL, Grizzle AJ, Babits L, Clark C, et al. Ability of pharmacy clinical decision-support software to alert users about clinically important drug–drug interactions. J Am Med Inform Assoc. 2011;18(1):32–7.

    Article  PubMed  Google Scholar 

  32. Rocha CE, Bispo ML, Alcantara TS, Brito GC, Vieira MJ, Lyra DP Jr. What do Brazilian community pharmacists know about self-medication for minor illnesses? A pilot study in the northeast of Brazil. J Appl Pharm Sci. 2014;4(5):012–20.

    Google Scholar 

  33. Rocha CE. Sistema de suporte à decisão clínica para intervenções farmacêuticas na prática da automedicação responsável [thesis]. São Cristovão, SE: Federal University of Sergipe; 2014.

  34. Agência Nacional de Vigilância Sanitária (ANVISA). Resolução nº 138, de 29 de maio de 2003. Dispõe sobre o enquadramento na categoria de venda de medicamentos. Diário Oficial da União; 2004.

  35. American Society of Health-System Pharmacists. ASHP statement on the pharmacist’s role in informatics. Am J Health Syst Pharm. 2007;64(2):200–3.

    Article  Google Scholar 

  36. Pharmacists Advancing Healthcare. ASHP. Residency accreditation [cited 2013 Dec 20]. http://www.ashp.org/accreditation-residency.

  37. Hämmerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41(11):1825–32.

    Article  PubMed  Google Scholar 

  38. Braund R, Furlan HM, George K, Havell MM, Murphy JL, West MK. Interventions performed by New Zealand community pharmacists while dispensing prescription medications. Pharm World Sci. 2010;32(1):22–5.

    Article  PubMed  Google Scholar 

  39. Pottegård A, Hallas J, Søndergaard J. Pharmaceutical interventions on prescription problems in a Danish pharmacy setting. Int J Clin Pharm. 2011;33(6):1019–27.

    Article  PubMed  Google Scholar 

  40. Martínez Sánchez A, Campos RM. Detection of prescribing related problems at the community pharmacy. Int J Clin Pharm. 2011;33(1):66–9.

    Article  PubMed  Google Scholar 

  41. Deschamps M, Dyck A, Taylor J. What are we saying? Content and organization of patient counselling by community pharmacists. Can Pharm J. 2003;136:42–7.

    Google Scholar 

  42. Benrimoj SI, Werner JB, Raffaele C, Roberts AS. A system for monitoring quality standards in the provision of non-prescription medicines from Australian community pharmacies. Pharm World Sci. 2008;30:147–53.

    Article  PubMed  Google Scholar 

  43. Vohra S, Gray N. Exploring pharmacists’ views about the responsible pharmacist role. Pharm J. 2012;289(7730):503.

  44. Woods J, Pasold TL, Boateng BA, Hensel DJ. Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation. Simul Healthc. 2013;8(6):359–67.

    Article  PubMed  Google Scholar 

  45. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.

    Article  PubMed  Google Scholar 

  46. Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144:742–52.

    Article  PubMed  Google Scholar 

  47. Cheng LT, Zheng J, Savova GK, Erickson BJ. Discerning tumor status from unstructured MRI reports—completeness of information in existing reports and utility of automated natural language processing. J Digit Imaging. 2010;23:119–32.

    Article  PubMed  Google Scholar 

  48. Grouin C, Deléger L, Rosier A, Temal L, Dameron O, Van Hille P, et al. Automatic computation of CHA2DS2-VASc score: information extraction from clinical texts for thromboembolism risk assessment. AMIA Annu Symp Proc. 2011;2011:501–10.

  49. Wagholikar KB, MacLaughlin KL, Henry MR, Greenes RA, Hankey RA, Liu H, et al. Clinical decision support with automated text processing for cervical cancer screening. J Am Med Inform Assoc. 2012;19:833–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. You JH, Wong FY, Chan FW, Wong EL, Yeoh EK. Public perception on the role of community pharmacists in self-medication and self-care in Hong Kong. BMC Clin Pharmacol. 2011;11:19.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Department of Health. Choice and opportunity—primary care: the future. London: Department of Health; 1996.

    Google Scholar 

  52. Philips Z, Whynes D, Parnham S, Slack R, Earwicker S. The role of community pharmacists in prescribing medication for the treatment of head lice. J Public Health Med. 2001;23:114–20.

    Article  CAS  PubMed  Google Scholar 

  53. Bojke C, Gravelle H, Hassell K, Whittington Z. Increasing patient choice in primary care: the management of minor ailments. Health Econ. 2004;13:73–86.

    Article  PubMed  Google Scholar 

  54. Smith F. Referral of clients by community pharmacists: views of general medical practitioners. Int J Pharm Pract. 1996;4:30–5.

    Article  Google Scholar 

  55. Hassel K, Noyce PR, Rogers A, Harris J, Wilkinson J. A pathway to the GP: the pharmaceutical ‘consultation’ as a first porto of call in primary health care. Fam Pract. 1997;14(6):498–502.

    Article  Google Scholar 

  56. Hassell K, Whittington Z, Cantrill J, Bates F, Rogers A, Noyce P. Managing demand: transfer of management of self limiting conditions from general practice to community pharmacies. Br Med J. 2001;323(7305):146–7.

    Article  CAS  Google Scholar 

  57. WHO. New tool to enhance role of pharmacists in health care. Geneva: World Health Organization; 2006.

    Google Scholar 

  58. Scottish Intercollegiate Guidelines Network. Dyspepsia. Guide-line number 68. SIGN, Edinburgh [cited 2014 Jan 10]. 2003. http://sign.ac.uk/pdf/sign68.pdf.

  59. Pande S, Hiller JE, Nkansah N, Bero L. The effect of pharmacist-provided non-dispensing services on patient outcomes, health service utilisation and costs in low- and middle-income countries. Cochrane Database Syst Rev. 2013;2(2). doi:10.1002/14651858.

  60. Center for the Advancement of Pharmaceutical Education (CAPE) Educational Outcomes [cited 2014 Jan 10]. 2004. http://www.aacp.org/resources/education/Documents/CAPE2004.pdf.

  61. Accreditation Council for Pharmacy Education. Accreditation Standards (ACPE) [cited 2014 Jan 12]. http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf.

  62. Jabbur-Lopes MO, Mesquita AR, Silva LMA, De Almeida Neto A, Lyra DP Jr. Virtual patients in pharmacy education. Am J Pharm Educ. 2012;76(5):92.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Benedict N. Virtual patients and problem-based learning in advanced therapeutics. Am J Pharm Educ. 2010;74(8):1.

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Acknowledgments

The authors thank all the participating clinical pharmacists for making this research possible as well as the production engineering students who were fundamental for carrying out this research.

Funding

This project was sponsored by FAPITEC-SE and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) in the form of grants (Ph.D. and scientific initiation scholarship).

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Authors and Affiliations

  1. Laboratory of Teaching and Research in Social Pharmacy (LEPFS/UFS), Federal University of Sergipe, Marechal Rondon Avenue, Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil

    Chiara E. da Rocha, Izadora M. C. Barros & Divaldo P. de Lyra Jr.

  2. Pharmacy Department, Federal University of Sergipe, Campus Prof. Antônio Garcia Filho, Street Padre Alvares Pitangueira, no 258, Centro, Lagarto, Sergipe, 49400-000, Brazil

    Chiara E. da Rocha

  3. Engineering Production Department, Federal University of Sergipe, Marechal Rondon Avenue, Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil

    Felipe A. S. Lessa, Daniel O. Venceslau & Celso S. Sakuraba

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  1. Chiara E. da Rocha
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  2. Felipe A. S. Lessa
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  3. Daniel O. Venceslau
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Correspondence to Divaldo P. de Lyra Jr..

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da Rocha, C.E., Lessa, F.A.S., Venceslau, D.O. et al. Development of a decision support system for the practice of responsible self-medication. Int J Clin Pharm 38, 152–161 (2016). https://doi.org/10.1007/s11096-015-0223-z

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