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Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba. Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba.
The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs.
The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type Granma und Granada ficken to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version.
The findings demonstrated that the instrument can be used at any level of health care. Demographic studies have shown an increase in the elderly population worldwide Medeiros et al.
Life expectancy reaches Consequently, healthcare strategies should be adopted to manage this situation. The elderly represents the demographic sector needing higher health care services and which consumes a large amount of drugs, generating significant expenses, and sometimes this demographic group makes an excessive use of either effective, dubious zero-efficacy drugs.
Pharmacotherapy follow-up is a practice Granma und Granada ficken which the pharmacist assumes the responsibility for the patient's drug-related problems aiming at achieving positive clinical outcomes. Several implicit methods have been described, for the development
Granma und Granada ficken the Pharmacotherapy follow-up service: All of these methods have been designed and implemented in different health contexts, being incorporated into standard operating procedures.
However, in their manufacture, consideration was not given to the peculiarities of the elderly with respect to the treatment of the problems related to the great geriatric syndromes Baster,the established criteria that define inappropriate prescriptions in these patients Fick et al. On the one hand, the Medication Appropriateness Index was specifically developed to assess the adequacy of drug therapy in the elderly.
Some authors describe it as a method for improving the prescription of specific drugs Stuijt et al. Otherwise, in Cuban health system, the development of Pharmaceutical Care and Pharmacotherapy follow-up is limited. There are some professional factors that influence in this context: Therefore, the exercise is developed as the result of the spontaneity of a few professionals Reyes, ; Dupotey, This transcends the fact that Cuban pharmacists have not been incorporated Granma und Granada ficken members of the interdisciplinary team of geriatric patient care.
This group is exposed to the big consumption of drugs, associated to their medical, psychological, social and functional conditions, increasing the risk of medication-related problems, with consequences for the patient's health, the health care institutions and society in general.
Albeit the development of research in the area of Pharmaceutical Care for the elderly is growing around the world, in Cuba, it is still insufficient. The instrument was designed and validated for inpatients pharmacotherapy follow-up, and is applicable to any population. But, its methodological structure does not respond to the identification and evaluation of main geriatric syndromes, associated with the use of drugs. It has been demonstrated that it is necessary to meet the pharmacotherapy needs of the elderly, Granma und Granada ficken as to prevent and resolve drug-related problems, by developing methodological tools, adapted to the bio-psycho-social peculiarities and the medication experiences of this population, which may allow for the provision of pharmacotherapy follow-up service, in a standardized and systematic manner, promoting the incorporation of pharmacists into interdisciplinary groups for geriatric patient care.
In this regard, the manuscript presents the design evaluation and the content validity of a standard operating procedure to provide pharmacotherapy follow-up to elderly patients institutionalized in nursing homes, in Cuba. This research study applied the Delphi Method Dalkey,to design and validate the contents of a Standard Operating Procedure in order to provide pharmacotherapy follow-up for the elderly, in nursing homes, in accordance with the Good Pharmacy Practice requirements OMS, and the process approach specified in ISO The study was conducted in the period from September to August The research design involved 5 phases: Construction of standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes.
The literature review included all relevant references published from todescribing and analyzing the following terms: Doctoral Thesis of Cuban and foreign authors in the area of Pharmaceutical Care were also reviewed. Each article or bibliographic material was systematically reviewed by the researchers using a table to outline the following information: After a documentary of literature,
Granma und Granada ficken steps were taken: At the beginning, potential participants with recognized
Granma und Granada ficken in pharmaceutical care research, pharmacotherapy follow-up; geriatric pharmacology, and clinical geriatric medicine, were invited by means of an invitation letter via regular email to be present and they were asked their consent to participate, through an informed consent form, to complete our survey.
The of the expert committee were selected from various geographic areas of Cuba.
Geriatricians or General Medicine Specialist with a degree in geriatrics regardless of the working place. The estimated sample included 13 specialists. The competence of the experts was calculated using two methods: The indicators used for the evaluation are shown in Table I.
Experts whose competence coefficient through both methods presented the following combinations: The Competence Coefficient K based on the analysis of each expert's curriculum, was calculated using the following equation:.
The competence coefficient of the expert was rated high, medium or low using the following criteria:. The expert panel was finally composed of nine specialists, out of which All of them completed two rounds of the study. So as to validate the contents of the procedure original versionexperts reviewed the printed version of the initial draft document, and then completed an assessment questionnaire.
The review was conducted using the Delphi method. Each panelist had the opportunity to make suggestions to improve each indicator of the SOP. After the analysis of the responses of the first round of the study, we examined each recommendation given so as to assess the modification or not of the SOP, and its subsequent evaluation in the second round. All the suggestions given by the experts, were summarized an evaluated for a second round, to reach a consensus among experts. In the 2nd the new version of the printed SOP was sent to the experts, with all suggestions in a document attached.
Experts' responses Granma und Granada ficken evaluated in accordance with Likert-Type Scale of 5 points, following the values: Statistical analysis of the indicators in each round was developed by applying the Delphi Method Software Hurtado, Each round was conducted in two weeks.
Once the responses and statistical analysis of the second round, were analyzed, the final version of the SOP was drawn up. Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly initial version. After reviewing the literature and the documentary analysis, the original version of the SOP was designed. The design included the following sections: The
Granma und Granada ficken, Applicability, Human resources involved, Reference documentation and Responsibilities differ from the other SOP proposals, specifying that the instrument is for the elderly institutionalized in nursing homes.
Section Definitions included core concepts Granma und Granada ficken to the pharmacotherapy follow-up service. Additionally, terms
Granma und Granada ficken with the use of medications in the elderly were incorporated: Section " Sequence of activities " included core Granma und Granada ficken that characterize the elderly care, such
Granma und Granada ficken. Each member should be highly familiarized with the tasks and responsibilities of the rest of the members, so that tasks and duties are, to some extent, interchangeable Beers, Berkow, Thus, the inclusion of patients into the pharmacotherapy follow-up service can be promoted by any of its members.
Based on the relationship between geriatric syndromes
Granma und Granada ficken drug use and the need for a holistic approach to the comprehensive care of the elderly, therefore it is considered a key element for case documentation. Identification and classification of DRPs: The list includes various types of DRP: Each drug-related problem identified, will allow to determine the therapeutic goal and the appropriate pharmacist's interventions to achieve it.
The criteria used for identifying prescription errors were based on the potentially inappropriate prescriptions for the elderly Fick et al.
Negative Outcomes associated with Granma und Granada ficken. The systematic identification and classification of NOM, the care plan implementation and the pharmacotherapy follow-up evaluation: The steps to identify and classify NOMs and the assessment of the interventions outcome, are described, modifying Reyes' criteria in Granma und Granada ficken et al.
Models conduct the initial interview and to draw up the pharmacotherapeutic profile for the elderly: The models included peculiarities of elderly associated to drug use: Besides, the pharmacotherapeutic profile was designed so as to achievea better traceability of the evaluation of the DRPs, the NOMs and the pharmacists' interventions, visits and consultations during patient therapy monitoring.
In Section Quality Assurance of Pharmacotherapy Follow-up a system of indicators of structure, process and results, was established.
They are shown in Table III. Negative Outcomes Associated with Medication. However, experts made some suggestions to improve the document in some Granma und Granada ficken its parts: All the suggestions made the experts individually in the 1st round, were evaluated by all in the 2nd round.
The results are shown in Table V. Out of the criteria to be assessed in the second round, 12 received favorable responses by the experts, finding consensus among Granma und Granada ficken. Therefore, the contents of the SOP were modified, according to the suggestions made in some sections. The three answers were unfavorable since there was not consensus among Granma und Granada ficken experts.
Sections Cover Page, Object, Applicability and Human Resources involved were modified, because most of the experts considered that the SOP use is not restricted to nursing homes, and it can be applied at any level of health care. Number "01" was included in the SOP code, being represented by the same acronym: The meaning of the auto shapes used in the Systematics for the detection and classification of NOMs Figure 1 and in the Systematics for the evaluation of the pharmacist's interventions in the pharmacotherapy follow-up Figure 2were specified.
Three phases were explained in the Section Sequence of activities Figure Granma und Granada fickenwhich were described as follows:. Granma und Granada ficken Outcomes associates with Medication.
Initial assessment of the patient: To determine the patient's drug-related needs in the order of the indication, effectiveness and safety, service offering to the patient, creating of the pharmacoterapeutic profile, documenting the case and identifying drug therapy problems DRPs and negative outcomes associated with medication NOMs.
Design and implementation of a therapeutic patient care plan: Establish goals of therapy, select appropriate interventions for: Monitoring and evaluation of pharmacotherapy follow-up results in the patient: The proposed changes relating to the incorporation of other types DRPs insufficient information provided by pharmacist about drug use, medication non-adherence and non-availability of drugswere accepted as shown in Table I.
Likely, the other suggestions issued by the experts were modified in the SOP. The diagram of the final SOP version is shown in Figure 4according to the results of both rounds.
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Granma und Granada fickenhealthcare providers in the interdisciplinary team. Geriatricians or General Medicine Specialist with a degree in geriatrics regardless of the working place. ABSTRACT Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services Granma und Granada ficken the Pharmaceutical Care practice, is nowadays a necessity. To include in dispensing errors "insufficient information provided by the pharmacist about the use of the drug".
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Granma und Granada fickenagreement among evaluators, was achieved, which Granma und Granada ficken to improve the initial version of the instrument and to construct the final procedure. Hausfrau Ficken - grown up incorporate ship aboard intrigue b passion up German lay To estimate the real availability of pharmacists providing pharmacotherapy follow-up. This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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